Pre-/Post-Surgical Care: Fractures, Joint Replacements, and Amputations EXAM 4

what are key assessments to be performed for the client with musculoskeletal injury/trauma?

• Neurovascular checks (CMS/Pulse/Capillary refill/Temperature/Sensation/Movement)

• Pain assessment — type, location, severity, response to meds

• Edema, swelling, deformity, bruising

• Skin integrity & color

• Range of motion

• Signs of infection (redness, warmth, drainage, fever)

• Compartment syndrome indicators — severe pain unrelieved by meds, pain with passive movement, tight compartments

• For fractures: limb alignment, shortening, rotation

Class note: compartment syndrome pain does not respond to meds, worsens with movement; do not elevate the limb

Prevention/Intervention for compartment syndrome

Frequent neurovascular checks,

do not elevate,

loosen constrictive dressings,

urgent fasciotomy

prevention/intervention for fat embolism syndrome?

Monitor respiratory status,

oxygen therapy,

early stabilization of fracture,

report petechiae

intervention/prevention for infection

Aseptic technique,

monitor labs/wound

, early antibiotics

intervention/ prevention for DVT PE

Early ambulation,

SCDs,

anticoagulants

prevention/intervention for Poor wound healing?

Nutrition,

glycemic control (↑ glucose postop = early infection sign)

prevention/intervention for Rhabdomyolysis (crush trauma)

IV fluids,

monitor electrolytes (esp. K+),

kidney function,

prevent dysrhythmias

what are considerations for client/family education related to body image changes?

• Provide emotional support & validate feelings

• Discuss temporary vs permanent limitations

• Offer connection to support groups/peer mentors

• Encourage involvement in self-care early

• Prosthetic expectations (below-knee > above-knee mobility)

  Client Requiring Orthopedic Pre…

• Reinforce independence adaptations + assistive devices

Body image impacts self-esteem, independence, social identity.

what are variations in care across the lifespan?

Population	Key Considerations
Pediatrics	Growth-plate fractures, cast care, parental teaching, traction, developmental needs (Perry)
Adults	Work/sports injuries, compartment syndrome, DVT
Older adults	Osteoporosis, high fall risk, slower healing, delirium assessment post-op THA/TKA

how would you collaborate with the interdisciplinary team?

• PT/OT — mobility, strength, home modifications

  Client Requiring Orthopedic Pre…

• Case management & social work — equipment, discharge planning

• Surgeon/Ortho team

• Pain management

• Dietitian — wound healing, protein/vitamin support

• Prosthetics team (amputations)

what should you teach?

• Cast/traction/external fixator care

• Signs of infection & complications

• Pain management strategies

• Weight-bearing restrictions

• Use of assistive devices (crutches, walker)

• Home safety (remove rugs, rails, lighting)

• Follow-up and when to call provider

• Stump care and phantom limb pain education

what is nursing care post op?

• Perform neurovascular & pain assessments routinely

• Strict infection prevention

• Early mobilization + PT/OT involvement

• DVT prophylaxis (SCDs, anticoagulants)

• Pain control (multi-modal)

• Monitor incision/drains/wound care

• Strict glucose monitoring post-op (infection risk indicator)

  Client Requiring Orthopedic Pre…

• Fall prevention

• Reinforce weight-bearing status

options for stabilizing fractures ?

Stabilization	Nursing Care
Splints/Casts	Elevate early, assess skin, cap refill, teach cast care
External fixation	Pin-site care, infection prevention, neurovascular checks Client Requiring Orthopedic Pre…
Traction	Maintain alignment, weights hang freely, skin care, prevent complications Client Requiring Orthopedic Pre…
Internal fixation (ORIF)	Post-op vitals, pain control, early mobility, DVT prevention
Joint replacement (THA/TKA)	Positioning devices, prevent dislocation, CPM, early PT Client Requiring Orthopedic Pre…
Amputation	Stump wrapping, pain mgmt (including phantom pain), psychosocial support