nursing care in traumatic orthopaedics...
TRANSCRIPT
![Page 1: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/1.jpg)
Nursing Care in Traumatic Orthopaedics injury
พว.นงเยาว ภรวฒนกล พยาบาลช านาญการพเศษ
หอผปวยศลยกรรมกระดกและชอชาย โรงพยาบาลสงขลานครนทร
![Page 2: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/2.jpg)
Traumatic Orthopaedic nursing
• ‘Trauma’ – an injury to living tissue that is caused by force or a mechanism extrinsic to the body (Lovell 1997)
• ‘Orthopaedic’ – the specialty of medicine that focused on the prevention and treatment of musculoskeletal disorders (judd 2010)
![Page 3: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/3.jpg)
Traumatic Orthopaedics Treatments
• Surgical treatment
Emergency case
• Conservative treatment
![Page 4: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/4.jpg)
Traumatic Orthopaedics Nursing Care
![Page 5: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/5.jpg)
Nursing Assessment
FRACTURE
Pain or tenderness
- Continuous and increases in severity
- Muscle spasm accompanies the fracture is a reaction of the body to immobilize the fracture bone
![Page 6: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/6.jpg)
Nursing Assessment
Loss of function
- Abnormal movement and pain
Deformity
- Displacement, angulations or rotation of the
fragments
Shortening
![Page 7: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/7.jpg)
Nursing Assessment
Crepitus
- A grating sensation produced when the bone fragments rub each other
Swelling
![Page 8: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/8.jpg)
Nursing Management
Traction
A method of fracture immobilization by applying equipment to align bone fragments
Used for immobilization, bone alignment and relief of muscle spasm
![Page 9: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/9.jpg)
Types
• Skin traction
The traction force applied over a large area of skin
• Skeletal traction
Applied directly to the bone either by pin or wire through the bone (eg – Steinmann pin, kirschner wire)
![Page 10: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/10.jpg)
![Page 11: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/11.jpg)
Complication of the skin traction
• Allergic reaction
• Excoriation of the skin
• Pressure sore
• Common peroneal nerve palsy
![Page 12: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/12.jpg)
Complication of the skeletal traction
• Infection into bone
• Incorrect placement of the pin
• Distraction of the fracture site deu to heavy weight
• Ligament damage
• Damage to epiphyseal growth plates
![Page 13: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/13.jpg)
Open fracture
• A fractured bone exposed to contamination from the external environment through a disruption of the skin and subcutaneous tissues
![Page 14: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/14.jpg)
• Infection is the most common complication of open fractures. Infection can occur early, during the healing phase of the fracture, or even later
• Open fractures may have difficulty healing
• Acute compartment syndrome
Complication of open fracture
![Page 15: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/15.jpg)
Nursing Management : Open fracture
• Pain Management
• Tetanus toxoid
• Antibiotic & side effect
• Wound care
• Psychology support
![Page 16: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/16.jpg)
Wound V.A.C. Dressing
![Page 17: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/17.jpg)
Pelvic Fracture • the pelvis is in proximity to major blood
vessels and organs, pelvic fractures may cause extensive bleeding and other injuries that require urgent treatment
![Page 18: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/18.jpg)
Wound healing problems, including infection
Damage to nerves or blood vessels
Pulmonary embolism
Complication of Pelvic Fracture
![Page 19: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/19.jpg)
Nursing Management : Pelvic Fracture
• Monitoring Hypovolemic shock
• Pain Management
• Prevent complication
![Page 20: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/20.jpg)
Nursing Management of Traumatic Orthopaedics Problem
PAIN Assess patient’s perception of pain
Instruction patient alternative pain management like meditation, heat and cold application
Administer analgesics as prescribed
* Usually NSAIDS
Assess the effectiveness of pain measures
![Page 21: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/21.jpg)
Nursing Management of Traumatic Orthopaedics Problem
Impaired Physical Mobility
Turn and change position every 2 hours
Instruction patient to perform range of motion exercises, either passive or active
Provide support in ambulation with assistive devices
![Page 22: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/22.jpg)
Nursing Management of Traumatic Orthopaedics Problem
Self care deficits
Assess functional levels of the patient
Provide support for feeding problems
Assist patient with difficulty bathing and hygiene
![Page 23: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/23.jpg)
Risk Management
• Fat embolism
• DVT (Deep Vein Thrombosis)
• Compartment syndrome
• Hypovolemic shock
• Infection
• Pressure sore
![Page 24: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/24.jpg)
Fat embolism
• FES is most commonly associated with orthopedic trauma, with highest incidence in closed, long bone fractures of the lower extremities, particularly the femur.
Circulation. 2015;131:317-320. DOI:
2015 American Heart Association, Inc.
![Page 25: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/25.jpg)
![Page 26: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/26.jpg)
Early warning sign : Fat embolism
- Sudden dyspnea and respiratory distress
- O2 saturation
- Tachycardia
- Chest pain
- Crackles, wheezes and cough
- Petechial rashes over the chest, axilla
![Page 27: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/27.jpg)
Petechial rashes over the chest, axilla
![Page 28: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/28.jpg)
• ABG : PO2 < 60 mmHg , PaCO2 < 55 mmHg Hemoglobin 3-5 gm% , Plt <150,000/mm
• Chest X-ray showing bilateral patchy infiltrates consistent with acute respiratory distress syndrome (ARDS).
![Page 29: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/29.jpg)
Nursing Management of Traumatic Orthopaedics Problem
FAT EMBOLISM
Support the respiratory function
- Administer O2 in high concentration
- Prepare for possible intubation and
ventilator support
![Page 30: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/30.jpg)
Nursing Management of Traumatic Orthopaedics Problem FAT EMBOLISM
Immobilization of fracture
Maintain hydration and electrolyte balance
Medication
![Page 31: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/31.jpg)
Compartment syndrome
• A painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.
http://orthoinfo.aaos.org/topic.cfm?topic=a00204
![Page 32: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/32.jpg)
neurovascular assessment
Pain : Deep, throbbing and unrelieved pain by opiods
Puffiness
Pallor
Polor
Pulselessness
Paralysis
Paresthesia
![Page 33: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/33.jpg)
Early warning sign : Compartment syndrome
The classic sign of acute compartment syndrome is pain
•The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
•There may also be tingling or burning sensations (paresthesias) in the skin.
•The muscle may feel tight or full.
•Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.
http://orthoinfo.aaos.org/topic.cfm?topic=a00204
![Page 34: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/34.jpg)
Nursing Management of Traumatic Orthopaedics Problem
Compartment syndrome Assess frequently the neurovascular status Remove external device Elevate limb to cardiac level Maintain blood pressure Oxygen supplement Avoid cold compression Cast removal and fasciotomy
![Page 35: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/35.jpg)
Deep Vein Thrombosis
![Page 36: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/36.jpg)
A Prospective Study of Venous Thromboembolism after Major Trauma
Risk for thrombosis is high in patients with spinal injuries (62%), pelvic fractures (61%), or leg fractures (80%), and it is low (19%) in people with lower limb plaster casts.
William H. Geerts, Karen I. Code, Richard M. Jay, Erluo Chen, and John Paul Szalai
N Engl J Med 1994; 331:1601-1606December 15
Deep Vein Thrombosis
![Page 37: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/37.jpg)
Early warning sign : Deep Vein Thrombosis
Swelling of leg
Tenderness in calf
Positive Homan’s sign
![Page 38: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/38.jpg)
Nursing Management of Traumatic Orthopaedics Problem
Deep Vein Thrombosis (prevention)
• Active/ passive exercise
• On pneumatic cuff continue > 18 hrs.
• Oral fluid > 2000 ml
• Elevate the extremity above
![Page 39: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/39.jpg)
Nursing process
The nursing process consists of five dynamic and interrelated phases :
1. Assessment
2. Nursing diagnosis
3. Planning
4. Implementation
5. Evaluation
![Page 40: Nursing Care in Traumatic Orthopaedics injurymedinfo.psu.ac.th/nurse/paper_meeting/ortho/ortho2.pdf · Nursing Assessment FRACTURE Pain or tenderness - Continuous and increases in](https://reader030.vdocuments.site/reader030/viewer/2022020411/5aa6426b7f8b9ac8748e3487/html5/thumbnails/40.jpg)