Flashcards in orthopedics Deck (16)
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1
fracture s/s
pain
tenderness
unnatural movement
deformity
shortening of extremity (r/t muscle spasms)
crepitus
swelling
discoloration
worry about compartment syndrome
2
fracture treatment
immobilize
support above and below site
little movement
splints help prevent fat emboli and muscle spasms
cover w/ sterile dressing for open fractures
****neurovascular checks (pulse, color, movement, sensation, CRT, temp)
3
fx complications
hypovolemic shock:
pelvic
crushing
long bone
fat embolism:
long bone (femur)
pelvic
crushing
s/s:
petechiae
rash over chest
conjunctival hemorrhages
snow storm on CXR
compartment syndrome:
increased pressure within a limited space
fluid accumulates in the tissue and impairs tissue perfusion
swollen muscle and hard with lots of pain
can result in nerve damage and amputation
***don't need to have fx to have this
treatment:
loosen cast to restore circulation
cast cutters to remove/loosen cast
cast saws (vibrates but does not touch skin)
fasciotomy (cuts into tissue to relieve pressure and restore circulation)
4
plaster cast care
ice packs on side for first 24hrs because cast is wet
used for complex fx
prevent indentions (no fingertips)
keep cast uncovered and allow for air drying
dont rest on hard surface or sharp edge
rest on soft pillow; no plastic
mark breakthrough bleeding
cover cast close to groin with plastic
neurovascular checks
most pain is relieved by elevation, cold packs, and analgesics (***if this does not relieve pain, think complications)
5
fiberglass cast care
dry within 30minutes
lightweight
waterproof
stronger
*** do not stick anything down-- use blow dryer on cool
can bear weight earlier
hard to mold and contour (Drys quick)
***simple fx
6
traction
**never release unless you have prescription because muscles will spasms
uses pulling force to reduce and immobilize fx
goal is to reduce spasms, pain, realign bones, and prevent deformities
continuous
weights hang free
keep them up in bed and centered
exercise non-immbolized joints
ropes should move free and knots should be secure
weights should not rest on floor
prevent foot drop (boot or high top sneakers)
7
skin traction
short term
relieve muscle spans
immobilize until surgery
tape, boot, or splint is on skin and weights pull against it
Buck's
skin assessment 3x/day
8
skeletal traction
directly to the bone with pins and wires
prolonged
Steinman pins, Crutchfield, Gardner-Wells tongs, Halo vest
pin sites assess q8hrs
pin care daily
***immobilize leg if pin falls out
9
total hip replacement
preop:
buck's traction
postop:
neurovascular checks
monitor drains
firm mattress
over bed trapeze to build upper body strength
neutral rotation (toes toward the ceiling)
limit flexion
extension of hip
abduction
isometric exercises
trochanter roll to prevent external rotation
**** no weight bearing until prescribed by HCP
avoid crossing legs/bending over
don't sleep on operated side
hydrate
no pain meds in hip
10
total hip replacement complications
dislocation (circulatory and nerve damage)
s/s:
shortening of leg
abnormal rotation
can't move extremity
***pain
infection:
prophylactic antibiotics
remove caths and drains asap
avascular necrosis (death of tissue r/t bad circulation)
immobility
11
total hip replacement education
walk
swim
rock
avoid flexion:
low chairs
traveling long distances
sitting more than 30minutes
lifting heavy
excessive bending/twisting
stair climbing
12
amputations
most distal point
post op:
tourniquet at bedside (hemorrhage)
extension to prevent knee/hip contractures
inspect residual limb daily to be sure that it lies flat
prone position to extend hip/knee joints
phantom pain:
***diversional activity, pain meds
*** least invasive first
13
amputation rehab
limb shaping important for prosthesis
shape stump as a cone
limb sock should be worn under prosthesis
can massage stump to promote circulation and decrease tenderness
toughen the stump:
press into soft pillow
then firm pillow
then bed
then a chair
***needs to be tough for prosthesis otherwise it'll hurt
14
walker
walk into a walker
15
crutches
1-2inch below axilla to decrease risk of brachial nerve damage
rest body weight on hands
up with the good leg (stairs)
down with the bad leg (stairs)
16
