Nursing care of patients undergoing orthopedic surgery

Nursing care of patients undergoing orthopedic surgeryIsaac AmankwaaOrthopedics is a branch of surgery that deals with conditions of the musculoskeletal system. Orthopedic surgeons use both surgical and non-surgical approaches. Orthopedics cure varied conditions such as degenerative diseases, tumors and musculoskeletal trauma.

Introduction Unstabilized fractureDeformity joint disease, necrotic or infected tissue, tumorsIndications for surgeryOpen reductionClosed reductionInternal fixation.Bone graft

Types of orthopedic SurgeriesArthroplastyrepair of a joint; Joint replacement type of arthroplasty that involves replacement of joint surfaces with metal or plastic materials.Total joint replacement replacement of both articular surfaces within a joint.Meniscectomy: excision of damaged meniscus (fibrocartilage) of the knee.

Types of orthopedic surgeries contdTendon transfer movement of tendon insertion point to improve function.Fasciotomy cutting muscle fascia to relieve constriction or contracture.Amputationremoval of a body partTypes of orthopedic surgeries contdInvolves removing a damaged joint and putting in a new one.The Indications include severe joint painisability fractures (eg, femoral neck fracture) Joints frequently replaced include the hip, knee, and finger joints. Joint Replacement

Metal and high-density polyethylene materials. Polymethyl methacrylate (PMMA) used to cement implants into prepared boneJoint replacement materialsPreoperative assessmentRoutine preoperative assessment Hydration status Medication historyPossible infection Ask specifically about colds, dental problems, urinary tract infections, infections within 2 weeks KnowledgeSupport and copingNursing InterventionsPostoperative assessment data are compared with preoperative assessment data to identify changes and deficits. Pain Vital signs, including respirations and breath soundsLOC Neurovascular status and tissue perfusionSigns and symptoms of bleedingwound drainage Mobility and understanding of mobility restrictionsBowel sounds and bowel eliminationUrinary output Signs and symptoms of complicationsDVT or infection

Post-operative careNeeds of Patients with Hip or Knee Replacement SurgeryMobility and ambulationPatients usually begin ambulation within a day after surgery using walker or crutches.Weight-bearing as prescribed by the physicianDrain use postoperativelyAssess for bleeding and fluid accumulationPrevention of infection Infection may occur in the immediate postoperative period (within 3 months), as a delayed infection (424 months), or due to spread from another site (more than 2 years)Prevention of DVTPatient teaching and rehabilitation11Hip ProsthesisPositioning of the leg in abduction to prevent dislocation of the prosthesesDo not flex hip more than 90 Avoid internal rotationProtective positioningHip precautionsAvoid bending forward when seated in a chair.Avoid bending forward to pick up an object on the floor.Use a high-seated chair and a raised toilet seat.

12Use of an Abduction Pillow to Prevent Hip Dislocation After Total Hip Replacement

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Hypovolemic shock AtelectasisPneumoniaUrinary retentionInfectionThromboembolismDVT or PEConstipation or fecal impaction14Potential ComplicationsPostoperative InterventionsMuscle setting, ankle and calf-pumping exercisesMeasures to ensure adequate nutrition and hydrationNote: Large amounts of milk should not be given to orthopedic patients on bed restSkin care measures including frequent turning and positioning Follow physical therapy and rehabilitation programs Encourage the patient to set realistic goals and perform self-care care within limits of the therapeutic regimen

15InterventionsPreventing atelectasis and pneumoniaEncourage coughing and deep breathing exercisesUse of incentive spirometryConstipationMonitoring of bowel functionHydrationEarly mobilizationStool softenersPatient teaching

16Also known as brittle-bone disease.Is a genetic (inherited) disorder characterized by bones that break easily without a specific causeOsteogenesis ImperfectaGenetic mutation

EtiologyCan result from autosomal dominant or recessive inheritance.Mutation change occurs in the DNA (the genetic code) within a gene that makes collagen, a major component of the connective tissues in bones, ligaments, teeth, and the white outer tissue of the eyeballs (sclera)The reticulum fails to differentiate into mature collagen or causes abnormal collagen developmentLeading to immature, coarse bone formation and cortical bone thinningResult in fragile bones that break easilyPathophysiologyMultiple fractures at birthBilaterally bulging skullTriangular shaped head and faceProminent eyesBlue or gray tinted scleraPain and bone swellingLoss of functionThin, translucent skinTeeth that breaks easily

Signs and SymptomsBreathing problemsDelayed walkingScoliosis as the child growsTinnitusHearing lossKidney stoneUrinary problems

Signs and SymptomsFamily history and characteristics features such as blue sclera or deafness.Complete medical history and physical examination.Skin biopsy to determine the amount and structure of collagen.X-ray showing evidence of multiple old and new fractures and skeletal deformities.Bone Mineral Density (BMD) testDiagnostic investigationsSupport limbs, do not pull on arms or legs or lift the legs to prevent more fractures or deformities.Position the patient withcare.Check the patients circulatory, motor, and sensory abilities.Provide emergencycareof fractures.Observe for signs of compartment syndrome.Encourage diet high in protein and vitamins to promote healing.Nursing InterventionsEncourage fluids to prevent constipation, renal calculi, and urinary tract infection.Providecarefor client with traction, with cast, or with open reduction.Encourage mobility when possible.Administer analgesics as prescribed.Teach the patient preventive measures.Monitor hearing needs.Aggressively teach all upper respiratory infections including

Nursing interventionPressure ulcerPneumoniaConstipationUrinary stasisInfection

ComplicationsOsteomyelitis is the Inflammatory process within the bone with an infectious cause. Bone infections are more difficult to treatOsteomyelitisDefinition

Bone infections are more difficult to eradicate than soft tissue infections because The infected bone becomes walled off. Natural body immune responses are blocked, and there is less penetration by antibiotics26Causative organisms include: Staphylococcus aureus (most common) Proteus, Pseudomonas species and Escherichia coli. The initial response to infection is inflammation, increased vascularity, and edema. After 2 or 3 days, thrombosis of the blood vessels occurs in the area, resulting in ischemia with bone necrosis. The infection extends into the medullary cavity and under the periosteum and may spread into adjacent soft tissues and joints.Unless the infective process is treated promptly, a bone abscess forms. The resulting abscess cavity contains dead bone tissue (the sequestrum), which does not easily liquefy and drain. Therefore, the cavity cannot collapse and heal, as occurs in soft tissue abscesses. New bone growth (the involucrum) forms and surrounds the sequestrum. Although healing appears to take place, a chronically infected sequestrum remains and produces recurring abscesses throughout the patients life. This is referred to as chronic

Pathophysiology