NCLEX Orthopedics

Fracture S/S

pain and tenderness

unnatural movement

deformity

shortening of limb (caused by muscle spasm)

crepitus

swelling

discoloration

worry about compartment syndrome

Fracture Treatment

immobilize bone ends and adjacent joints

support fracture above and below site

move extremity as little as possible

Splints

help prevent fat emboli and muscle spasms

What do with open fractures?

preferably cover with something sterile

Most important thing with fractures

neurovascular checks

pulses, color, movement, sensation, cap refill, and temp

Fracture Complications

hypovolemic shock

fat embolism

compartment syndrome

Shock often happens with these fractures

pelvic

crushing fractures

multiple long bone fractures

When do you typically see fat emboli?

long bone fractures

pelvic

crushing injuries

Fat emboli S/S

petechiae or rash over chest

conjunctival hemorrhage

snow storm on CXR

can cause altered mental status if goes to lungs or brain and causes hypoxia

young males common

Compartment Syndrome

try to prevent

increased pressure in limited space

Compartment Syndrome Patho

fluid accumulates in the tissue and impairs tissue perfusion

muscle becomes swollen and hard and client reports severe pain that is not relieved by pain meds

pain is disproportionate to injury

can cause nerve damage and amputation

Common Areas for compartment syndrome

forearm, quads, and tibia

Compartment Syndrome Treat

loosen cast to help circulation

be careful picking the answer that says remove the cast - least invasive first

cast cutters to remove or loosen cast

Cast Saws explain

the cast does not touch the skin but it does vibrate

Fasciotomy

PCP cuts down into the tissue to relieve some of the pressure and restore circulation

Cast Care Plaster

place ice packs on either side of cast for first 24 hours because cast is still wet

prevent indentations - can cause pressure injuries - only palms for 24-72 hours

keep cast uncovered and allow for air drying

do not rest on hard surface or edges

rest on soft pillow no plastic because causes too much heat

mark breakthrough bleeding area

cover cast close to groin with plastic once dry

neurovascular checks esp if reports pain

Pain relied

elevation, cold packs, pain meds. if those dont work thing complication

Fiberglass Cast Care

dry within 30 minutes

lightweight, waterproof, and stronger

easier to Xray

allow client to bear weight earlier

difficult to mold and contour

simple fractures

Pro Cast Tip

do not stick anything down your cast! can cause infection or injury

Miscellaneous Info traction

uses pulling force to reduce and immobilize fractures

reduce muscle spasms, realign bone, and prevent deformities

Should traction be intermittent or continuous

continuous

weights hang freely

keep client pulled up in bed and centered with good alignment

exercise free extremities

ropes move freely

special mattresses good

prevent foot drop with foot drop boot

Testing Strategy

never release traction without doc orders

Skin Traction

short term to help muscle spasms or immobilize until surgery

tape, boot, or splint applied directly to skin and weights pull against it

no skin penetration

often called Buck’s traction

do good skin assessments - could tear skin off

ankle and achilles focus

Skeletal Traction

applied directly to bone with pins and wires

used when prolonged traction needed

Steinman pins, Crutchfield, Gardner, Wells tongs, and Halo vest

monitor pin sites every 8 hours for inflammation or infection

sterile technique

serous drainage ok

Preop for total hip replacement

Buck’s traction

Post op care for total hip replacment

neuro checks

monitor drain

firm mattress

over bed trapeze to build upper body support

Hip Replacment Position

neutral rotation - toes to ceiling

limit flexion - only extension of the hip

abduction is better - triangle pillow

What can they do while confined to bed

isometric exercises

Trochanter Roll

prevents external rotation

document in nurses notes

Avoid these things

crossing legs or bending over

sleep on operated side

dehydration

no pain meds in operative hip

Hip Replacement Complications

dislocation

infection

avascular necrosis

immobility problems

Dislocation S/S

shortening of leg, abnormal rotation, cant move extremity, abnormal pain

Infection

prophylactic antibiotics, remove catheters and drains as soon as possible

Client Rehab

walk, swim, rock

avoid flexion, low chairs, long distance travel, sitting for more than 30 minutes, lifting heavy objects, excessive bending or twisting

Amputations

performed at most distal point that will heal

preserve knees and elbows

Immediate Post op cre

tournequit at bedsde

prevent contractures with splints

inspect residual limb daily for flat lying on bed

prone to extend knees

Phantom Pain

diversional activity

seen more with AKAs

usually subsides within 3 months

Residual limb shap

cone or torpedo

Ok to massage limb?

yes promotes circulationWal

Walker

you walk into a walker

Crutches

1-2 inches below axilla

body weight on hands

up with good leg down with bad leg on stairs

Canes

use on strong side of body