timby /smith : introductory medical-surgical nursing, 10/e

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith : Introductory Medical-Surgical Nursing, 10/e

Timby/Smith : Introductory Medical-Surgical Nursing, 10/e

Chapter 61: Caring for Clients Requiring Orthopedic Treatment 01/24 Pg 969


Words to Know [12]Words to Know [12]• Arthroplasty Avascular Necrosis Brace

• Cast Closed Reduction

• External Fixation Internal Fixation

• Open Reduction Prosthesis

• Splint Subluxation

• Traction

02/24 Pg 969


Learning ObjectivesOn completion of this chapter, you will be able to


• Differentiate types of casts.

• Discuss the nursing management for a client with a cast

• State the reasons for using splints or braces.

• Identify the principles for maintaining traction and describe nursing care for the client in traction.

• Differentiate between closed reduction and open reduction and between internal fixation and external fixation.

• Describe nursing care for the client with a fracture reduction.

03/24 Pg 969




• Identify the reasons for performing orthopedic surgery.

• Discuss the nursing management for a client undergoing orthopedic surgery.

• Describe the positioning precautions after a conventional total hip replacement.

• Explain the nursing needs of the client undergoing total knee replacement.

• Discuss amputation, including reasons it may be performed and appropriate nursing management of the client

04/24 Pg 969


Casts 05/24 Pg 969Casts 05/24 Pg 969

Types of Casts

Cylinder Cast Body Cast Hip Spica Cast


CastsCasts• Cast Composition

– Fiberglas; Plaster of Paris

– Alignment and support of the fractured area

– Cast material feels warm during application

– Support drying cast on pillows [Palms]

• Cast Windows [If]

– Client reports discomfort

– Wound requires regular dressing change 06/24 Pg 971


QuestionQuestion

Is the following statement true or false?

When a limb is placed in a cast, the joint is set straight to assure bone alignment. [NCLEX TYPE]

07/24 Pg 969


AnswerAnswer

False.

When a limb is placed in a cast, the cast is applied from the joint above the break to the joint below the break. The joint is slightly flexed to decrease joint stiffness. The Reduction aligns the bone ends

08/24 Pg 969


CastsCasts• Bivalve Cast Used:

– With swollen arm or limb

– When being weaned from a cast

– When sharp radiograph is needed

– As a splint

• Cast Removal [Vibrating saw]

• Nursing Management

09/24 Pg 971


Splints, BracesSplints, Braces• Splints

– Immobilize and support an injured body part in a functional position

• Braces

– Provide support

– Control movement

– Prevent additional injury

• Provide client and family education10/24 Pg 971


QuestionQuestionIs the following statement true or false?

Braces provide support, control movement, and prevent additional injury.

11/24 Pg 971


AnswerAnswerTrue.

Braces provide support, control movement, and prevent additional injury for long-term use. They are made of various materials and are custom fit to the client. Scrupulous skin care is vital to maintain skin integrity.

12/24 Pg 971


Reducing Fractures 13/24 Pg 971Reducing Fractures 13/24 Pg 971

Cast

Application

External Fixation

Internal Fixation

Open

Reduction

Closed Reduction

Traction

Treatment of Fractures


Reducing Fractures 14/24 Pg 973Reducing Fractures 14/24 Pg 973

Figure 61-3 Examples of skin traction

Figure 61-6 External fixation


Orthopedic SurgeryOrthopedic Surgery• Open Reduction Internal Fixation

– Buck’s extension

– Nails; Intramedullary rod

– Internal fixation devices

• Joint Dysfunction Correction

– Arthroplasty; Arthrodesis

– Osteotomy; Hemiarthroplasty

– Total arthroplasty

15/24 Pg 973


Orthopedic Surgery Complications 16/24 Pg 979Orthopedic Surgery Complications 16/24 Pg 979

Loosening

of cemented prosthesis

Avascular

Necrosis

Thrombo-embolism

Infection

Subluxation

Hemorrhage

Postoperative Complications


Orthopedic SurgeryOrthopedic Surgery• Preoperative Nursing Management

– Obtain complete history

– Assess complications from previous treatment

– Assist in reducing pain, risk of infection, and increasing mobility

– Help control anxiety and understand instructions

17/24 Pg 980


Orthopedic Surgery Orthopedic Surgery

• Postoperative Nursing Management

– Required demonstrations

– Postsurgery devices

– Reduce risk for excessive bleeding

– Review physician orders

• Flexion of CPM devices and movement

– Help reduce pain and inflammation

– Prevent postoperative complications

18/24 Pg 980


Orthopedic Surgery Orthopedic Surgery

• Client and Family Teaching

– Support system after discharge

– Explore the kinds of assistance needed

– Modifications needed in the home environment

– Information about home care

– Referral to a home healthcare agency

– Printed discharge instructions

• Activity; PT; Symptoms to report19/24 Pg 980-981


AmputationAmputation• Etiology

– Amputation rationale

• Medical, Surgical Management

– Treatment for disorder influencing healing

– Level at which limb is amputated

– Amputation methods: Open (guillotine); Closed (flap)

20/24 Pg 984Figure 61-8


Amputation 21/24 Pg 984Amputation 21/24 Pg 984

• Medical, Surgical Management (Cont’d)

– Arm amputation

– Leg amputation

• Attachment of temporary prosthesis to plaster shell

• Custom-made conventional prosthesis

Types of prostheses

Shoulder harness, cables, and hook

Semifunctioning cosmetic hand

Myoelectric arm


AmputationAmputation• Medical, Surgical Management (Cont’d)

– Complications 22/24 Pg 985

Postoperative Complications

Immediate Complications• Hematoma

• Hemorrhage• Infection

• Pain

Late Complications • Chronic Osteomyelitis

• Causalgia• Phantom Limb • Phantom Pain


Amputation 23/24 Pg 985Amputation 23/24 Pg 985

• Medical, Surgical Management (Cont’d)

– Phantom limb; Phantom pain

• Potential phenomenon

• Physiologic response

– Rehabilitation

• Factors influencing amputee success

• Maintain realistic expectations

• Nursing Management


NCLEX Questions Pg 967-968

End of Presentation

By:

P.K. Williams, RN

[email protected] 25/25 Pg 988

timby /smith : introductory medical-surgical nursing, 10/e

Documents