Nku Nrs250 - Orthopedics *part 2

Front 1

Encases portions of one or two extremities; consists of a body jacket cast and a long leg cast.

Back 1

Spica Cast

Front 2

Cast that encircles trunk.

Back 2

Body Jacket Cast

Front 3

6 Complications of Casts

Back 3

Infection
Neurovascular compromise
Compartment Syndrome
Fat Embolism
Hazards of immobility
Disuse Syndrome (muscle atrophy)

Front 4

Cast Care & Patient Education

Back 4

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.

Front 5

Spica Cast Care

Back 5

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)

Front 6

Cast Syndrome S/s

Back 6

Abdominal pain & distention, N/V, and decreased bowel sounds.

Front 7

Cast Syndrome Treatment

Back 7

Gastric decompression with NG tube.
Cast my need to be bivalved or removed.

Front 8

Post Cast Removal Care

Back 8

X-ray to confirm healing
Skin care (re-casting=do not wash; else wash and oil to remove dead skin)
Physical Therapy PRN

Front 9

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

Back 9

Traction

Front 10

Two Types of Traction

Back 10

Skin - 48-72hr, 5-10lbs, Buck's & Russell
Skeletal - pins, screws, wires, through bone. 5 - 45lbs

Front 11

8 Principles of Traction

Back 11

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

Front 12

9 Traction Complications

Back 12

Skin breakdown
Muscle Weakness / Atrophy
Constipation / Anorexia
Isolation
Pain / Infection
Neurovascular compromise
Atelectasis / Pneumonia
Urinary stasis
Venous Thromboembolism

Front 13

Used when internal fixation is contraindicated- often to treat open fractures or when a cast would not allow proper alignment of the fracture

Back 13

External Fixation

Front 14

Nursing Care: External Fixation

Back 14

Pin Care
Never adjust hardware
Never use device to move extremity
Encourage isometric activity
Disturbed body image
May still need cast.

Front 15

Surgical treatment of fracture using pins, screws, rods, plates or prosthesis to stabilize. Permits early mobilization.

Back 15

Open Reduction with Internal Fixation
(ORIF)

Front 16

3 Locations of Hip Fractures

Back 16

Head, Neck, Trochanter

Front 17

4 Hip Fracture S/s

Back 17

Inability to move leg except with severe pain.
Externally rotated
Shortening.
Decreased ROM

Front 18

3 Treatments for Hip Fractures

Back 18

Buck's traction until surgery
ORIF
Femur head fracture = prosthesis (total hip replacement)

Front 19

Pre-Op Care of Hip Fracture

Back 19

Treat chronic health problems
Treat pain
Education (use of trapeze, exercise chair transfers, discharge plans)

Front 20

Post-Op Care of Hip Fracture

Back 20

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

Front 21

3 Indications for Arthroplasty

Back 21

Relieve pain
Improve or maintain ROM
Correct deformity

Front 22

Hip Fracture Nutrition

Back 22

High Protein
High Calorie
Vitamins B & C
Calcium
Iron for anemia

Front 23

Total Hip Replacement: Monitoring for Dislocation

Back 23

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

Front 24

Total Hip Replacement: Dislocation S/s

Back 24

Pain at surgical site, swelling and immobilization
Acute groin pain
Shortening
Abnormal internal or external rotation
Inability to move leg or restricted
Popping sensation

Front 25

4 Immediate Complication of Fractures

Back 25

Fat Embolism
Venous Thromboembolism
Compartment Syndrome
Infection

Front 26

Late Complications of Fractures

Back 26

Malunion
Delayed union
Non-union
Avascular necrosis
Chronic Osteomyelitis

Front 27

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

Back 27

Fat Embolism (FES)

Front 28

Fat Embolism: Triad of Symptoms

Back 28

Acute Respiratory Failure
Neurological Dysfunction (pt becomes confused)
Petechial Rash (conjunctiva, inner cheeks, neck and axilla)

Front 29

Fat Embolism: Treatment

Back 29

Prevention
Support Respiratory System
High Fowlers
High concentration O2
Corticosteroids (decrease lung inflammation & cerebral edema)

Front 30

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.

Back 30

Venous Thromboembolism

Front 31

Venous Thrombosis S/s

Back 31

Depends on size of thrombi
Labored or rapid breathing
Tachycardia
Pallor / Cyanosis
Chest Pain
Confusion
Impending doom

Front 32

Venous Thrombosis: Diagnosis

Back 32

ABGs
ECG
VQ Scan
Venous doppler

Front 33

Venous Thrombosis: Treatment

Back 33

Prevention
Hydration
Passive ROM
Ambulation ASAP
Stockings
Compression devices
Anticoagulant

Front 34

Expected range of compartmental pressure.

Back 34

0 - 10 mmHg

Front 35

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

Back 35

Acute Compartmental Syndrome (ACS)

Front 36

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

Back 36

Malunion

Front 37

A fracture slow to heal but does demonstrate some calcification.Caused by infection, inadequate immobilization or reduction, inadequate blood supply, metabolic disturbances.

Back 37

Delayed Union

Front 38

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.

Back 38

Non-union

Front 39

Acute Compartment Syndrome: Treatment

Back 39

Prevention & recognition
Extremity not raised above heart
Ice packs
Bivalve cast
Surgical decompression (fasciotomy

Front 40

A transplant from one person to another, but not an identical twin.

Back 40

Allograft

Front 41

Tissue transplanted from one part of the body to another in the same individual.

Back 41

Autograft

Front 42

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

Back 42

Osteomyelitis

Front 43

Develops 3-4 days after injury; anaerobic bacteria; infection breaks down tissue causing gas.

Back 43

Gas Gangrene

Front 44

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

Back 44

Avascular Necrosis

Front 45

General Nursing Management of Fracture Complications

Back 45

Identify complication
Patient education
Treat complications