PREOPERATIVE CARE

PREOPERATIVE NURSING CARE

Corrects volume depletion and any electrolyte imbalances Decreases blood viscosity and venous stasisEnsures adequate urine flowPrevents complications brought by immobilization such as DVT, Pulmonary embolism, Urinary stasis and associated bladder infections

ADEQUATE HYDRATION

IV fluidsMonitor intake and output

Elevation of the affected extremitiesTo promote venous return and reduce discomfortCold compress If prescribed, relieves swelling and diminish nerve stimulation. Thus, reducing discomfort. Administer medications as prescribed Paracetamol (Acetaminophen), Tramadol or Morphine

RELIEVING PAINPROMOTE CIRCULATION

Aside from elevation, it is essential to release constricting wraps or clothing The injured part is supported when it is movedEncourage movement within the limits of therapeutic immobility (unless contraindicated). Use of trapeze to facilitate movement.

Assist in performing active ROM exercises of uninvolved extremities. To strengthen the extremities needed for the use of assistive devices postoperatively. Provide health teachings regarding proper use of assistive devices.

IMPROVE MOBILITY

Do not eat or drink anything 8 hours prior to surgery.Do not take aspirin, NSAIDs, anti-inflammatory or blood thinning medications for 2 weeks prior to your surgery. It can alter coagulation and other biochemical process

NPOPOSTOPERATIVE NURSING CAREFrequent assessment of vital signs including pain, level of consciousness, neurovascular status, wound drainage, breath sounds, bowel sounds, circulation and fluid balance.Check dressing daily for bleeding and infectionEmpty hemovac: serosanguinous drainage (thin, watery and a clear pink color) is normalObserve adequate bowel and bladder function

Implement measures to prevent thrombus formationElastic hoseDorsiflexion of footEncourage tolerable exercisesProvide assistance in activities of daily livingAvoid weight-bearing activities on affected extremities.Ice TherapyBegin immediately after surgery. Use every 2 hours for 20 minutes daily until first post-operative visit. It relieves pain and swelling

Clear liquids or soft diet is started when bowel sounds returnedDIETPOSITIONINGLow fowler position To relieve pressure off of certain nerves or to allow gravity to help with problems such as breathing and blood flow. Turn to unoperative side only. To prevent pressure on the operative sidePlace two pillows between legs while turning and lying on sideProvide instructions regarding proper use of assistive devices such as walker, cane or crutch.PATIENT EDUCATION

Up with the good, down with the badTYPES OF CASTS

Care of the client with CastCarry the newly-casted body part with palms of the hand to prevent indentation and pressureElevate the body part with pillow support. To prevent edemaExpose the cast to dry. Dry cast appears white, shiny, hard and resonant. Sensation of heat as the cast is drying is normal. The cast should not be covered with a blanket or towel while it is drying because the retained heat can burn the patient.Keep the cast clean and dryPlaster of paris dries within 48 hours or longer especially larger casts.Fiberglass cast may dry in 10 to 16 minutes

Care of the client with Cast

Observe hot spots and musty odor or drainage from the cast. It may indicate sign and symptoms of infection.Do neurovascular checksSkin colorSkin temperatureSensationMobilityPulse

WindowingDone to facilitate observation under the cast. It is also done to assess pulse, skin integrity or to prevent cast syndrome. This procedure involves removal of a part of the cast.Bivalving Done for wound care or X-rays. It is also done when the cast is too tight or when healing process has occurred. This procedure involves splitting of the cast.

BIVALVINGHypovolemic ShockThis is due to massive bleeding

Fat EmbolismFollows fracture of the long bones. The development of FES is attributed to a series of biochemical cascades resulting from the mechanical insult sustained in major trauma. Release of fat emboli leads to occlusion of the microvasculature, triggering an inflammatory response that is clinically manifested by dermatologic, pulmonary, and neurologic dysfunction.WATCH FOR COMPLICATIONSPulmonary consequences are usually the initial manifestation of FES, appearing within 24 hours after the traumatic insult. They result from injury to the pulmonary capillary endothelium caused by free fatty acids that were hydrolyzed by lipoprotein lipase, releasing local toxic mediators. These mediators cause increased vascular permeability, resulting in alveolar hemorrhage and edema and causing respiratory failure and ARDS

Nerve PalsyFollows fracture of the leg. This results to footdrop.

Avascular Necrosis

Decreased bone tissue perfusion leads to bone tissue death. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated.

Compartment Syndrome

This results from fractures of arms or legs where closed compartments are presentA compartment contains blood vessels, nerves, muscles which are enclosed by fascia. It is manifested by bloated feeling, prolonged nausea, repeated vomiting, abdominal distention, abdominal pain and shortness of breath

Collaborative ManagementElevate extremity above the level of the heart to prevent further edema. Notify physician. It may cause ischemia and tissue necrosisRemove tight dressing or cast

Assess for circulation

Surgery: fasciotomy with delayed primary closure of wound, 3-5 days after to allow edema of compartment to subside.