Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 61: Caring for Clients Requiring Orthopedic Treatment

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Casts Cylinder Body Hip spica

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Casts Cast Composition –Fiberglass; plaster of paris –Alignment and support of the fractured area –Cast material feels warm during application. –Support drying cast on pillows Cast Windows –Client reports discomfort. –Wound requires regular dressing change.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? When a limb is placed in a cast, the joint is set straight to assure bone alignment.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: When a limb is placed in a cast, the cast is applied from the joint above the break to the joint below the break. The joint is slightly flexed to decrease joint stiffness.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Casts—(cont.) Bivalve cast is used –With swollen arm or limb –When being weaned from a cast –When sharp radiograph is needed –As a splint Cast Removal Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Splints and Braces Splints –Immobilize and support an injured body part in a functional position. Braces –Provide support. –Control movement. –Prevent additional injury. Provide client and family education.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Braces provide support, control movement, and prevent additional injury.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Braces provide support, control movement, and prevent additional injury for long-term use. They are made of various materials and are custom fit to the client. Scrupulous skin care is vital to maintain skin integrity.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Traction Management –Cast application –Traction –Closed reduction –Open reduction –Internal fixation –External fixation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Orthopedic Surgery Open Reduction Internal Fixation –Buck’s extension –Nails; intramedullary rod –Internal fixation devices Joint Dysfunction Correction –Arthroplasty; arthrodesis –Osteotomy; hemiarthroplasty –Total arthroplasty

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Orthopedic Surgery—(cont.) Preoperative Nursing Management –Obtain complete history. –Assess complications from previous treatment. –Assist in reducing pain, risk of infection, and increasing mobility. –Help control anxiety and understand instructions.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Orthopedic Surgery—(cont.) Postoperative Nursing Management –Required demonstrations –Postsurgery devices –Reduce risk for excessive bleeding. –Review physician orders Flexion of CPM devices and movement –Help reduce pain and inflammation. –Prevent postoperative complications.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Orthopedic Surgery—(cont.) Client and Family Teaching –Support system after discharge. –Explore the kinds of assistance needed. –Modifications needed in the home environment –Information about home care –Referral to a home healthcare agency –Printed discharge instructions Activity, PT, symptoms to report

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Positioning Precautions: Hip Replacement –Have legs abducted with pillows or abductor cushion and extended because the opposite positions of adduction and flexion beyond 90° can dislocate the prosthetic femoral head from the acetabulum. –Sit in an elevated chair or on a seat raised by pillows, so that the flexion remains less than 90°.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Knee Replacement Clients with knee replacements have the amount of flexion and the frequency of use increased daily while hospitalized. The goal is for the client to have the ability to bend the knee 90° by discharge. The amount of flexion for clients with hip replacements should never exceed 30° in a CPM machine.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Amputation Etiology –Amputation rationale Medical and Surgical Management –Treatment for disorder influencing healing –Level at which limb is amputated –Amputation methods: open (guillotine); closed (flap)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Amputation—(cont.) Medical and Surgical Management—(cont.) –Arm amputation –Leg amputation Attachment of temporary prosthesis to plaster shell Custom-made conventional prosthesis

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Amputation—(cont.) Medical and Surgical Management—(cont.) –Phantom limb; phantom pain Potential phenomenon Physiologic response –Rehabilitation Factors influencing amputee success Maintain realistic expectations Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question By the time of discharge from the hospital, a patient with a knee replacement should bend the knee how many degrees? A) 30° B) 45° C) 60° D) 90°

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D) 90° Rationale: The goal is for the client to have the ability to bend the knee 90° by discharge.