Orthopaedic Nursing Interventions

Orthopaedic Nursing Interventions

Big Ideas

  1. Identify various surgical and non-surgical orthopaedic injuries

    • Understanding the types of injuries that can occur, both requiring surgical intervention and those manageable without surgery.

  2. Apply focused assessments and neurovascular assessments for orthopaedic clients

    • Performing detailed assessments to evaluate the blood flow and neurological function in patients with orthopaedic issues.

  3. Demonstrate nursing management of the postoperative orthopaedic client

    • Providing care and monitoring for patients who have undergone surgical procedures related to orthopaedic conditions.

  4. Plan appropriate actions to prevent and/or treat complications

    • Developing strategies to avoid common postoperative complications in orthopaedic patients, as well as addressing any issues that arise.

Fracture Classifications

Basic Classification

  • Fractures can be classified as:

    • Open: The broken bone protrudes through the skin.

    • Closed: The broken bone does not break through the skin.

Incomplete vs. Complete Fracture

  • Incomplete Fracture: The bone has cracked but does not completely break into pieces.

  • Complete Fracture: The bone breaks into two or more pieces, such as with a radius fracture.

Fracture Types by Orientation

  1. Transverse: A straight across the bone fracture.

  2. Spiral: A fracture caused by a twisting or rotational force.

  3. Greenstick: An incomplete fracture on one side of the bone, common in children.

  4. Comminuted: The bone is shattered into several pieces.

  5. Oblique: A fracture that occurs at an angle.

  6. Stress: A small crack in the bone often caused by repetitive force.

  7. Pathologic: A fracture caused by a disease that weakens the bone (such as osteoporosis).

Nursing Assessment

Clinical Manifestations

  • Understanding the mechanism of injury is crucial as it is associated with numerous signs and symptoms which must be assessed during initial evaluation.

Treatment Options

  • Closed reduction: Non-surgical procedure to align bone fragments.

  • Buck's extension: A type of skin traction used to relieve muscle spasms and immobilize the limb.

Patient Care Guidelines: Do's and Don'ts

Recommendations
Do's

  • Ensure that the cast remains dry by covering it with a plastic bag while bathing or showering.

  • Elevate the affected arm or leg above heart level using pillows or a recliner to minimize pain and swelling.

  • Exercise the joints near the cast (like fingers, toes, elbow, or knee) to improve blood circulation.

  • Use any supportive tools (e.g., crutches, sling) as directed by the healthcare provider.

Don'ts

  • Do not insert any objects into the cast to scratch the skin; this can cause injury and increase infection risk.

  • Avoid cutting or pulling the padding from inside the cast.

  • Refrain from driving or lifting anything heavy until the cast is removed.

Types of Traction

  • Buck's extension: A method used for traction in orthopedic injuries, specifically in certain fractures.

  • Cervical traction: Focuses on the neck and is used to treat C-spine injuries or conditions.

Surgical Interventions

Open Reduction Internal Fixation (ORIF)

  1. Pre-Surgical Assessment:

    • Ensuring stabilization of bones using metallic plates and screws.

    • The procedure involves realigning the bones and securing them with hardware for proper healing.

Post-Surgical Care

  • Monitoring for signs of complications, including the assessment of pain, pulse, paresthesia (tingling sensations), pallor (pale skin), and paralysis.

Ambulation Support

Use of Assistive Devices

  • Crutch Measurement:

    • Standing Position: Crutches should be positioned with tips 15 cm (approximately 6 inches) to the side and 15 cm in front of the client’s feet. The crutch pads should be set about 5 cm (2 inches) below the axilla.

Positioning Post-Total Hip Arthroplasty

  • After hip replacement, positions should align with angles no greater than 90 degrees to prevent dislocation.

Nursing Management: Other Measures

  • Compartment Syndrome

    • History and Physical Examination: Clinicians should inquire about the "6 P's" of compartment syndrome, which comprise:

      • Pain: Increasing pain that is disproportionate to the injury.

      • Pressure: Escalating pressure within the muscle compartments.

      • Paresthesia: Tingling or numb sensations in the affected area.

      • Pallor: Skin discoloration indicating reduced blood flow.

      • Pulselessness: Weak or absent pulse in the extremity.

      • Paresis: Weakness or inability to move the affected limb.

Complications to Monitor For

Fat Embolism

  • A serious condition that can occur after fractures, characterized by fat globules entering the bloodstream and potentially causing respiratory distress and organ dysfunction.