Presentation is loading. Please wait.

Presentation is loading. Please wait.

Nursing of Adults with Medical & Surgical Conditions Fractures & Complications of Fractures.

Similar presentations

Presentation on theme: "Nursing of Adults with Medical & Surgical Conditions Fractures & Complications of Fractures."— Presentation transcript:

1 Nursing of Adults with Medical & Surgical Conditions Fractures & Complications of Fractures

2 Arthroplasty n Knee Arthroplasty (total knee replacement) –Replacement of the knee joint –Restore motion of the joint, relieve pain, or correct deformity

3 Arthroplasty n Hip Arthroplasty (total hip replacement) –Replacement of the hip joint

4 Arthroplasty n Nursing Interventions –Empty and record hemovac –Give oxygen 2-3 l/min –Incentive spirometer q 2hrs –Cough and deep breathe q 2hrs –Record I&O –Bed rest hrs –Change dressing as ordered –Diet as ordered –Neurovascular checks q1hr x24, q2hrs x24, then q4hrs –Vital sighs q 4hrs –Maintain position of operative area –Physical therapy will initiate ambulation and prescribe routine –Encourage fluid intake –Antiembolisim stockings –Avoid adduction and hyperflexion of hip

5 Fracture of the Hip n Etiology/pathophysiology –Most common type of fracture –Women higher risk due to osteoporosis –Types of hip fractures Intracapsular –inside the joint Extracapsular –outside the hip joint

6 Fracture of the Hip n Signs & Symptoms –Severe pain at site –Inability to move the leg voluntarily –Shortening or external rotation of the leg

7 Fracture of the Hip n Diagnostic Tests –Radiographic examination –Hemoglobin may be decreased because of bleeding

8 Fracture of the Hip n Treatment –Bucks or Russells traction until surgery –Surgical repair Internal fixation –Neufeld nail and screws –Kuntscher nail (intramedullary rod) Prosthetic implants –Austin Moore prosthesis –Bipolar hip replacement (hemiarthroplasty)

9 Fracture of the Hip n Postoperative interventions –Wound assessment –Vital signs –Assessment of drains Jackson-Pratt, Hemovac –Incentive spirometer –Turning q 2 hours –Antiembolic stockings –Anticoagulation therapy

10 Fracture of the Hip –Maintain leg abduction abduction pillow –Turn to unoperative side –Limit weight bearing on affected side –Chairs and commode seats should be raised to prevent flexion of hip beyond 60 degrees

11 Fracture of the Hip n Patient teaching for ORIF –Assess ability to understand –Assist to dangle at bedside –No weight on operative side –Turn every 2 hours, maintain abduction –Assist with ROM –PT will instruct as to ambulation and weight bearing –As pt. progresses, encourage to continue to ambulate only with assistance

12 Fracture of the Hip n Patient Teaching for Hip Prosthetic Implant –Avoid hip flexion beyond 60 degrees for approximately 10 days beyond 90 degrees for 2 to 3 months –Avoid adduction of the affected leg beyond midline for 2 to 3 months –Maintain partial weight bearing for approx. 2 to 3 months –Avoid positioning on the operative side in bed –Maintain abduction of the hip –DO NOT list

13 DO NOT List

14 Other Fractures n Etiology/Pathophysiology –A traumatic injury to a bone in which the continuity of the tissue of the bone is broken. –Pathological or spontaneous fractures occur without trauma osteoporosis, metastatic cancer and bone tumors

15 Types of Fractures n Open (compound) –Protrusion of the bone through the skin –Require surgical repair –Prone to infection

16 n Closed (simple) –Bone has NOT protruded through the skin –May be realigned by external manipulation

17 Types of Fractures n Greenstick fracture –Incomplete fracture –Extends only partially through the bone –Common in children because bones are more flexible

18 Types of Fractures n Complete fracture –Fracture line extends entirely through the bone with the periosteum disrupted on both sides of the bone

19 Types of Fractures n Comminuted fracture –Bone is splintered into three or more fragments at the site of the break –More than one fracture line

20 Types of Fractures n Impacted fracture –One bone fragment is forcibly wedged into another bone fragment.

21 Types of Fractures n Transverse fracture –Break runs directly across the bone.

22 Types of Fractures n Oblique fracture –Break runs along a slant to the length of the bone.

23 Types of Fractures n Spiral fracture –Break coils around the bone. –Usually caused by a twisting force.

24 Types of Fractures n Colles Fracture –Distal portion of the radius within 1 inch of the joint of the wrist –Commonly occurs when a person attempts to break a fall by putting their hands down

25 Types of Fractures n Potts Fracture –Occurs at the distal end of the fibula –A piece of the medial malleolus chips off. Posterior Left Foot Medial Malleolus

26 Fractures n Bone Repair

27 Assessment n Seven Ps of Orthopedic Assessment –Pain Does it seem out of proportion to the patients injury? Does it increase with active or passive motion? –Pallor –Paresthesia or numbness –Paralysis –Polar Temperature Is it cold compared to opposite extremity? –Puffiness from edema or hematoma –Pulselessness

28 Fractures n Signs & Symptoms –Pain –Loss of normal function –Obvious deformity –Change in the curvature or length of bone –Crepitus (grating sound with movement) –Soft tissue edema –Warmth over injured area –Ecchymosis of skin surrounding injured area –Loss of sensation distal to injury –Signs of shock (injury, blood loss, & pain)

29 Fractures n Diagnostic Tests –Radiographic examination

30 Fractures n Treatment (Immediate) –Splinting to prevent edema –Body alignment –Elevation of body part –Application of cold packs, first 24 hours –Administration of analgesics –Observation for change in color, sensation, or temperature –Observe for signs of shock

31 Fractures n Treatment (Secondary Management) –Closed (simple) closed reduction traction open reduction with internal fixation device immobilization –external fixation device –traction –internal fixation devices; pins, screws, plates

32 Fractures n Treatment (secondary management) –Open (compound) Surgical debridement of wound –remove dirt, tissue, etc. Administration of tetanus toxoid Culture of wound Observation for signs of infection Closure of wound Reduction of fracture Immobilization of fracture Treatment of complications

33 Fracture of the Vertebrae n Etiology/pathophysiology –Diving accidents –Blows to the head or body –Osteoporosis –Metastatic cancer –Motorcycle and car accidents –Displaced fracture may place pressure on or sever the spinal cord nerves

34 Fracture of the Vertebrae n Signs & Symptoms –Pain at site of injury –Partial or complete loss of mobility or sensation below level of injury –Evidence of fracture/ fracture dislocation on x-ray

35 Fracture of the Vertebrae n Treatment –Stable injuries pain medication muscle relaxants back support, brace or cast –Unstable fractures Traction –Cranial skeletal traction »Halo brace –Pelvic traction Open reduction –Harrington rod

36 Fracture of the Pelvis n Etiology/pathophsiology –Trauma involving great force falls from extreme heights automobile accidents crushing accidents

37 Fracture of the Pelvis n Signs & Symptoms –Unable to bear weight without discomfort –Pelvic tenderness and edema –Hematuria (bladder trauma) –Signs of shock

38 Fracture of the Pelvis n Treatment –Bed rest for approx. 3 weeks –Ambulate with crutches for approx. 6 weeks –More severe fractures may require surgery and/or spica or body cast

39 Complications of Fractures n Compartment Syndrome –Cause Caused by the progressive development of arterial vessel compression and reduced blood supply to an extremity. –Signs & Symptoms Sharp pain with movement, numbness or tingling in the affected extremity, cool & pale or cyanotic, slow capillary refill

40 Complications of Fractures –Treatment Fasciotomy (incision into the fascia) –Complication Volkmanns contracture (clawhand)

41 Complications of Fractures n Shock –Cause –Blood loss, pain, fear –Signs & Symptoms –Altered level of consciousness –Restlessness –Hypotension, tachycardia, & tachypnea –Pale, cool, moist, skin –Treatment –Restore blood volume »IV fluids - LR »Administer blood –Oxygen –Shock trousers

42 Complications of Fractures n Fat Embolism –Cause Emoblization of tissue fat with platelets Most common with multiple fractures and long bone fractures –Signs & Symptoms Irritability, restlessness,disorientation, stupor, and coma due to hypoxemia Chest pain and dyspnea –Treatment IV fluids Steroids (reduce inflammation) Digoxin (increase cardiac output) Oxygen

43 Complications of Fractures n Gas Gangrene –Cause Severe infection of the skeletal muscle by Clostridium bacteria –Signs & Symptoms Pain at site of injury Gas bubbles under the skin Signs of infection Necrotic skin at site Foul odor from wound drainage –Treatment Excision of gangrenous tissue Antibiotics - Penicillin G or Keflin Strict aseptic technique

44 Complications of Fractures n Thromboembolus –Cause Blood vessel is occluded by an embolus –Signs & Symptoms Area may tingle and become cold, numb, and cyanotic Embolus in the lungs cause a sharp thoracic or upper abdominal pain, dyspnea, cough, fever, and hemoptysis –Treatment Anticoagulants –Heparin and/or coumadin

45 Complications of Fractures n Delayed Fracture Healing –Delayed Union Fails to heal within the usual time Healing is impaired but will eventually repair itself –Nonunion Failure of the ends of the fractured bone to unite Fails to unite and produce a stable union after 6-9 months Requires bone grafting, prosthetic implant, internal fixation, external fixation, or a combination of these methods Electrical stimulation –New method to promote healing –Stimulates bone production

46 External Fixation Devices n Skeletal Pin External Fixation –Immobilizes fractures by the use of pins inserted through the bone an attached to a rigid external metal frame –Pin Care Assess every 8 hours for s/s of infection Remove exudate and clean with hydrogen peroxide using aseptic technique

47 Skeletal Pin External Fixation


49 Nonsurgical Interventions n Casts –Made of layers of plaster of paris, fiberglass, or plastic roller bandages. –Stockinette applied, a sheet of wadding, and then casting material –Nursing Assessment Neurovascular assessment q 15 to 30 min. for first few hours then q 4hours Assess skin at the cast edges for erythema and irritation. Assess for odor or drainage from under cast

50 n Cast Removal –Uses a vibrating saw Does not cut Causes fine powder –Wear mask –Skin Care Gently remove buildup of secretions and dead skin by washing and apply lotion –May take several days –Be careful not to remove rapidly, can cause skin impairment –Muscle Atrophy Reassure patient that the muscle will regain strength and size with proper exercise

51 Traction n The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys to: –align and stabilize a fracture site –relieve pressure on nerves –maintain correct positioning –prevent deformities –relieve muscle spasms

52 Types of Traction n Skeletal –Applied directly to a bone –The pin protrudes through the skin on both sides of the extremity and weights are attached to a rope –Used for fractures of the femur, tibia, humerus, and cervical spine

53 Balanced Suspension Skeletal Traction

54 Tibial Pin Traction with Steinmann Pin

55 Types of Traction n Skin Traction –Uses weight that pulls on sponge rubber, moleskin, elastic bandage with adherent, or plastic material attached to the skin below the fracture, with the pull exerted on the limb.

56 Types of Traction –Bucks Used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated Traction in in horizontal plane with affected extremity

57 Types of Traction –Russell Traction Similar to Bucks except that a knee sling is used to provide support to the affected leg. Used to treat hip and knee fractures

58 Types of Traction –Bryants Traction Both legs are suspended at a 90 degree angle to the trunk of the body and the weight of the lower body pulls the bone fragments of the fractured leg into alignment Used for small children with fractured femurs

59 Amputation n Amputation of a portion of or an entire extremity –Malignant tumors –Injuries –Impaired circulation –Congenital deformities –Infections

60 Amputation n Postoperative Nursing Interventions –Raise foot of bed to elevate extremity do not elevate on pillow, may cause contracture –Encourage movement from side to side & place in prone position at least 2 times a day to stretch muscles –Teach strengthening exercises –Elastic wraps to shape residual extremity –Assess for respiratory complications, esp in elderly –Phantom-limb pain is normal

Download ppt "Nursing of Adults with Medical & Surgical Conditions Fractures & Complications of Fractures."

Similar presentations

Ads by Google