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Orthopedics - Coggle Diagram
Orthopedics
Fractures
S/S:
-pain and tenderness
-unnatural movement
-deformity (possible)
-shortening of extremity
-crepitus (bones grating together)
-swelling
-discoloration
-worry about compartment syndrome
Treatment
-immobilize the bone ends plus the adjacent joints (prevent further injury)
-support fracture above and below site (prevent further injury)
-move extremity as little as possible (prevent further injury)
-splints help prevent fat emboli and muscle spasms
-Open fracture? Cover with something sterile
-Neurovascular checks: pulse, color, movement, sensation, capillary refill, temperature.
Complications:
Shock:
-depends on amount of trauma and type of injury
-shock specifically with: pelvic fractures, crushing fractures, multiple long bone fractures
Fat embolism
-See this in long bones, pelvic fractures, crushing injuries
-S/S: depends where embolus goes: petechiae or rash over chest, conjunctival hemorrhage, snow storm on CXR
-young males (risky behavior)
-first 36 hours after injury
Compartment syndrome: try to prevent. Increased pressure within a limited space.
-Patho: fluid accumulates in tissue and impairs tissue perfusion. Muscle becomes swollen and hard and client reports severe pain that is not relieved with meds. Pain disproportionate to injury. May result in nerve dmg and amputation. Common areas are forearms and quads.
-Treatment: loosen cast to restore circulation
Fasciotomy: PCP cuts down into tissue to relieve pressure and restore circulation.
Cast Care
Plaster casts
-Place ice packs on the side of the cast first 24hrs because the cast is still wet
-Prevent indentations: can cause pressure sores.
-Keep cast uncovered and allow air drying
-Do not rest on a hard surface or sharp edge
-Rest on soft pillow, no plastic
-Mark breakthrough bleeding. Circle area and date/time site.
-Cover cast close to groin with plastic once dry
-Neurovascular checks with 5Ps
-If pain reported: neurovascular checks. Elevate/cold packs/analgesics. If pain is unrelieved think complications.
Fiberglass casts
-Dry within 30 minutes
-Adv: lightweight, waterproof, stronger than plaster
-X-ray images better quality than with plaster.
-Allow client to bear weight earlier
-Disadv: difficult to mold and contour
-Primarily for simple fractures
Traction: pulling force to reduce and immobilize fractures. Goal is to reduce muscle spasms, pain, realign bones, and prevent deformities.
-Traction is continuous.
-Weight should hang freely
-Keep client pulled up in bed and centered with good alignment.
-Exercise the non-immobilized joints
-Ropes should move freely and knots should be secure.
-Prevent foot drop, a foot drop boot.
Skin traction:
-Short term to relieve muscle spasms and immobilize until surgery
-Tape/boot/splint/material applied directly to the skin and weights pull against it
-Skin is not penetrated
-Must do good skin assessments 3x a day.
Skeletal traction
-Applied directly to the bone with pins and wires
-Used when prolonged tension is needed.
-Must monitor pin site q8hrs.
-Pin care begins 48-72 hours after insertion. Sterile technique. Serous drainage is okay.
Total Hip Replacement
-
Post-op care
-Neurovascular checks
-Monitor drains
-Firm mattress to support joints
-Over bed trapeze to build upper body strength
-Positioning: toes pointed to ceiling to maintain neutral rotation. Limit flexion (want extension of hip). Abduction.
-Isometric exercise while in bed.
-Trochanter roll prevents external rotation.
-No weight bearing until prescribed by the PCP.
-Avoid crossing legs or bending over.
-Do not sleep on operated side.
-Hydrate
Complications
- Dislocation: circulatory and/or nerve dmg. S/S: shortening of leg, abnormal rotation, can't move extremity, pain
- Infection: prophylactic antibiotics. Remove indwelling catheters and drains asap.
- Avascular necrosis: death of tissue d/t poor circulation
- Immobility problems
Client education/teaching
-Best exercises: walking/swimming/rocking
-Avoid flexion (low chairs, traveling long distances, sitting more than 30 mins, lifting heavy objects, excessive bending/twisting, stair climbing)
Amputations:
-Done at the most distal point that will heal
-Surgeon tries to preserve the knee or elbow
Immediate post-op care:
-Keep tourniquet at bedside for massive hemorrhage
-Prevent hip/knee contractures with extension
-Inspect residual limb daily to be sure it lies completely flat on the bed
-Prone position helps extend the hip/knee joints.
-Phantom pain: diversional activity as first intervention, then meds. Seen more in AKAs. Usually subsides in 3 months.
Rehabilitation
-Limb shaping important for prosthetics
-Want the stump cone shaped
-Limb sock worn under the prosthesis.
-Strengthen upper body for crutches or walker use
-Massage the stump to promote circulation/decrease tenderness.
-Toughen the stump by gradually increases the hardness of the surface being pressed against: press into a soft pillow > firm pillow > bed > chair.
-Walk into the walker.
-Crutches 1-2 inches below axilla to decrease risk of nerve dmg. Rest body weight on hands.
-Stairs: up with good leg, down with bad leg.
-Canes: use on strong side of body.