2 Cast A rigid, external immobilizing device Uses Immobilize a reduced fractureCorrect a deformityApply uniform pressure to soft tissuesSupport to stabilize a jointMaterials—nonplaster (fiberglass), plaster
3 Long-Arm and Short-Leg Cast and Common Pressure Areas
4 Teaching Needs of the Patient with a Cast or Splint ExercisesDo not scratch or stick anything under castCushion rough edgesSigns and symptoms to report: persistent pain or swelling, changes in sensation, movement, skin color or temperature, signs of infection or pressure areasRequired follow-up careCast removal
5 Collaborative Problems/Potential Complications Compartment syndromePressure ulcerDisuse syndromeDelayed union or nonunion of fracture(s)
6 Interventions Relieving pain Elevation to reduce edema Intermittent application of ice or coldPositioning changesAdministration of analgesicsNote: Unrelieved pain may indicate compartment syndrome; discomfort due to pressure may require change of castMuscle-setting exercisesPatient teaching
7 Interventions Healing skin wounds and maintaining skin integrity Treat wounds to skin before the splint or cast is appliedObserve for signs and symptoms of pressure or infectionMaintaining adequate neurovascular statusAssess circulation, sensation, and movementFive “P’s”Notify physician of signs of compromiseat onceElevate extremity no higher than theheartEncourage movement of fingers or toesevery hour
8 External Fixation Device Used to manage open fractures with soft tissue damagePatient requires reassurance due to appearance of deviceDiscomfort is usually minimal and early mobility may be anticipated with these devices.Elevate to reduce edema
9 Traction The application of pulling force to a part of the body Purposes:Reduce muscle spasmsReduce, align, and immobilize fracturesReduce deformityUsed as a short-term intervention until other modalities are possible
11 Principles of Effective Traction Traction must be continuous to reduce and immobilize fractures.Skeletal traction is never interrupted.Weights are not removed unless intermittent traction is prescribed.Any factor that reduces pull must be eliminated.Ropes must be unobstructed and weights must hang freely.Knots or the footplate must not touch the foot of the bed.
12 Types of Traction Skin traction Skeletal traction Buck’s extension tractionCervical head halterPelvic tractionSkeletal traction
14 Balanced Skeletal Traction with Thomas Leg Splint
15 Nursing Care Needs of the Patient in Traction Proper application and maintenance of tractionMonitor for complications of skin breakdown, nerve pressure, and circulatory impairmentInspect skin at least three times a dayAssess sensation and movementAssess pulses, color, capillary refill, and temperature of fingers or toesAssess for indicators of DVTAssess for indicators of infection
16 Preventative Interventions Promptly report any alteration in sensation or circulationFrequent back care and skin careRegular shifting of positionSpecial mattresses or other pressure reduction devicesPerform active foot exercises and leg exercises every hourElastic hose, pneumatic compression hose, or anticoagulant therapy may be prescribedTrapeze to help with movement for patients in skeletal tractionPin careExercises to maintain muscle tone and strength
17 Joint ReplacementsUsed to treat severe joint pain and disability and for repair and management of joint fractures or joint necrosis.Frequently replaced joints include the hip, knee, and fingers.Joints including the shoulder, elbow, wrist, and ankle may also be replaced.
18 Needs of Patients with Hip or Knee Replacement Surgery Mobility and ambulationPatients usually begin ambulation within a day after surgery using walker or crutches.Weight-bearing as prescribed by the physicianDrain use postoperativelyAssess for bleeding and fluid accumulationPrevention of infectionInfection may occur in the immediate postoperative period (within 3 months), as a delayed infection (4–24 months), or due to spread from another site (more than 2 years)Prevention of DVTPatient teaching and rehabilitation
19 Hip ProsthesisPositioning of the leg in abduction to prevent dislocation of the prosthesesDo not flex hip more than 90°Avoid internal rotationProtective positioningHip precautionsAvoid bending forward when seated in a chair.Avoid bending forward to pick up an object on the floor.Use a high-seated chair and a raised toilet seat.
20 Use of an Abduction Pillow to Prevent Hip Dislocation After Total Hip Replacement
21 Recognize dislocation of the prosthesis Increased pain at the surgical site, swelling, and immobilizationAcute groin pain in the affected hip or increased discomfortShortening of the legAbnormal external or internal rotationRestricted ability or inability to move the legReported “popping” sensation in the hip
22 Knee Prostheses The knee is dressed with a compression bandage. Ice may be applied to control edema and bleeding.Encourage active flexion exercisesUse of continuous passive motion (CPM) device
23 Nursing Process: The Care of the Patient Undergoing Orthopedic Surgery—Assessment, Preoperative Routine preoperative assessmentHydration statusMedication historyPossible infectionAsk specifically about colds, dental problems, urinary tract infections, infections within 2 weeksKnowledgeSupport and coping
24 Nursing Process: The Care of the Patient Undergoing Orthopedic Surgery—Assessment, Postoperative PainVital signs, including respirations and breath soundsLOCNeurovascular status and tissue perfusionSigns and symptoms of bleeding—wound drainageMobility and understanding of mobility restrictionsBowel sounds and bowel eliminationUrinary outputSigns and symptoms of complications—DVT or infection
25 Nursing Process: The Care of the Patient Undergoing Orthopedic Surgery—Diagnoses Acute painRisk for peripheral neurovascular dysfunctionRisk for ineffective therapeutic regimen managementImpaired physical mobilityRisk for situational low self-esteem and/or disturbed body image
26 Collaborative Problems/Potential Complications—Postoperative Hypovolemic shockAtelectasisPneumoniaUrinary retentionInfectionThromboembolism—DVT or PEConstipation or fecal impaction
27 Nursing Process: The Care of the Patient Undergoing Orthopedic Surgery—Planning Major goals preoperatively and postoperatively may include the relief of pain, adequate neurovascular function, health promotion, improved mobility, and positive self-esteem.Postoperative goals include the absence of complications.
28 Relief of Pain Administration of medications Patient-controlled analgesia (PCA)Other medicationsMedicate before planned activity and ambulationUse alternative methods of pain reliefRepositioning, distraction, guided imagery. etc.Specific individualized strategies to control painUse of ice or coldElevationImmobilization
29 Interventions Muscle setting, ankle and calf-pumping exercises Measures to ensure adequate nutrition and hydrationNote: Large amounts of milk should not be given to orthopedic patients on bed restSkin care measures including frequent turning and positioningFollow physical therapy and rehabilitation programsEncourage the patient to set realistic goals and perform self-care care within limits of the therapeutic regimen
30 Interventions Preventing atelectasis and pneumonia Constipation Encourage coughing and deep breathing exercisesUse of incentive spirometryConstipationMonitoring of bowel functionHydrationEarly mobilizationStool softenersPatient teaching