Caring for Clients Requiring Orthopedic Treatment
What does the success of an amputees rehabilitation depend on?
Age, type of amputation, condition of the stump, physical status, condition of the remaining limb, concurrent debilitating illness, visual-motor coordination, motivation, acceptance, and cooperation
Before sending a client home after surgery, the nurse should do what, regarding the clients home?
Identify modifications that will be necessary, such as relocating the bed to a ground floor level
When would a bivalve cast be used?
If the arm or leg swells, a client is being weaned from a cast, when a sharp x-ray is needed, or as a spint
What is an important nursing intervention related to the nursing diagnosis of Risk for Disuse Syndrome?*
Place a client with a leg amputation in the prone position several times a day to promote stump extension and prevent contractures
The intake of what nutrients should be increased in clients receiving orthopedic treatment?
Protein and fiber
What is external fixation?**
When the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins
What is necessary for the nurse to determine, if a clients disorder was treated previously?**
Whether and complications or problems occurred because of or during treatment
What is a short arm cast?**
a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. If the thumb is also casted, it is referred to as a thumb spica or gauntlet cast
What is a splint?**
a device that immobilizes and supports an injured body part in a functional position
Body cast
a larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests
Cast
a rigid mold that immobilizes, aligns, and supports an injured structure while it heals
What prosthesis are available for arm amputees?
a shoulder harness with cables that attach to a mechanical terminal device (hook), a semifunctioning cosmetic hand, and a myoelectric arm
What are examples of surgical procedures to correct joint deformity?
arthrodesis, arthroplasty, hemiarthroplasty, total arthroplasty, and osteotomy
What is an important nursing implication related to the nursing diganosis Acute Pain?
change the clients position within prescribed limits, to relieve pressure on bony prominences and promote comfort
What is the pattern of occurrence of phantom pains?*
They can persist for months or decades, or can come and go
What is disadvantage and an advantage of a plaster of Paris cast?**
They require longer time for drying but mold better to the client and are intentionally used until the swelling subsides
Why shouldn't you use your fingertips or a hard surface while supporting a drying cast?
This can cause the cast to push against the skin and could lead to a pressure sore
What is a short leg cast?*
A cast that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position.
What machines should a client who has undergone knee or hip replacement use?*
A continuous passive motion (CPM) machine
What are some principles of effective traction?**
(Make sure that the weights hang freely, not on the floor), be sure that ropes move freely through each pulley, apply the exact amount of weight prescribed
The amount of flexion for clients with hip replacment should never exceed how many degrees?**
30
What is traction?
A method of pulling structures of the musculoskeletal system
What is a myoelectric arm?
A prosthetic that has a realistic-looking hand that is activated by electrical impulses from muscles in the upper arm
What is very important for clients who have knee or hip replacement?**
Anticoagulant therapy and early ambulation
If a client is scheduled for a knee or hip replacement, what should the nurse withhold from the client?*
Aspirin before the surgery to reduce the risk for excessive bleeding
Why should a client with a total hip replacement have the legs abducted with pillows or abductor cushion and extended?**
Because the opposite positions of adduction and flexion beyond 90 degrees can dislocate the prosthetic femoral head from the acetabelum
Ideally, when does postoperative nursing being?*
Before the surgery
What are two examples of skin traction?
Bucks traction and Russell's traction
How is skin traction achieved?**
By applying devices to the skin that indirectly affect the muscles or bones
What kind of injuries do Crutchfield cranial tongs effect?*
Cervial spine fractures
What are the potential complications in the late postoperative period of amputation?
Chronic osteomyelitis, and burning pain
What should be assessed immediately after application of a cast?*
Circulation, (sensation, and mobility) in exposed fingers and toes every 1-2 hours
What is the first step in applying a cast?**
Clean and dry the skin surface of the part to be casted
What two materials are casts general made of?
Fiberglass, or plaster (plaster of Paris)
What are the potential complications in the immediate postoperative period of amputation?**
Hematoma, hemorrhage, pain, and infection
What instructions should a nurse provide to the client about a brace?
Instructions on how to apply the brace and to administer scrupulous skin care to prevent irritation and injury
What are the advantages of a myoelectric arm?*
It eliminates the need to wear a harness, the terminal device looks natural, and it has somewhat better function than the cosmetic hand
How can the crust be removed from the skin?**
It usually sheds in a few days, (but lotions and warm baths or soaks may help to soften the skin and remove debris)
How should a cast be supported while it dries?
On pillows
What is an important nursing implication related to the nursing diagnosis Impaired Tissue Integrity ?*
Massage bony prominences and skin surfaces subjected to pressure, unless they remain red when pressure is relieved
What is used to stabilize a fracture in internal fixation?
Metal screws, plates, rods, nails, or pins
How will the skin appear, once a cast is removed?*
Mottled and may be covered in a yellowish crust composed of accumulated body oil and dead skin
What are examples of types of casts?
Short arm cast, long arm cast, short leg cast, long leg cast, walking cast, body cast, shoulder spica cast, hip spica cast
What is closed amputation? (flap)
Skin flaps cover the severed bone end
If the client is awake during the cast application, what should the healthcare professionals explain to them about the feeling of the cast application?
The cast material will feel warm during application as a result of being mixed with water
What is an expected outcome for a nursing diagnosis of Impaired Tissue Integrity?*
The client will demonstrate adequate wound healing without infection
Why are porous-coated cementless joints components often used instead of traditional prosthesis?*
These allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place
What is phantom pain?
The feeling that the amputated portion of the limb still remains
What is Bucks traction used for?*
The relief of muscle spasms and pain in clients with fracture femers that have surgery delayed
What is skeletal traction?
Tractions that is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield)
After a knee or hip replacement, the client should notify the physician if what is present?**
Unusual drainage at the incision site, fever, chills, sudden onset of pain, redness, or swelling
What are important points to prevent infection when providing pin care?*
Use at least one applicator per pin, do not use applicator more than once, gently remove crusts around the pin sites, obtain a culture if purulent drainage is present
What is closed reduction?*
When a bone is restored to its normal position by external manipulation
What is open reduction?**
When a bone is surgically exposed and realigned in the operating room
When would a client use a splint?*
When a musculoskeletal position (does not require rigid immobilization), causes large degree of swelling, (requires special skin treatment, such as the monitoring of a sutured laceration)
When is a cast window created?*
When the client reports discomfort under the cast or (has a wound that requires a dressing change)
What are braces?
devices that provide support, control movement, and prevent additional injury
Cylinder cast
encircles an arm or leg, leaving the fingers or toes exposed
What is the goal of a CPM machine?*
for the client to have the ability to bend the knee 90 degrees by discharge
Postoperative complications after surgical procedures to correct joint disfunction
hemorrhage, subluxation, infection, thromboembolism, and avascular necrosis
For what conditions may amputation be performed?
malignant tumors, long standing infections of bone and tissue that prohibit restoration of function, extensive trauma to an extremity, death of tissues, thermal injuries, deformity rendering a limb a hindrance, life-threatening disorders
Because the pin sites are an entry for infection, what is necessary?
monitoring for redness, drainage, and tenderness
Hip Spica cast
surrounds one or both legs and the trunk
If an amputee is acutely ill, what should the nurse monitor?
the client circulation in the limb for changes, such as severe pain, color changes, and lack of peripheral pulses
What is an open amputation? (guillotine)
the end of the residual limb is temporarily open with no skin covering it
What is an arthodesis?**
the fusion of a join (most often the wrist or knee) for stabilization and pain relief
What is staged amputation?
the guillotine method is first used, then a few days later a closed amputation is done
What is a total arthroplasty?*
the replacement of both articular surfaces within one joint
When is open reduction required?**
when (soft tissues, suck as nerves or blood vessels, are caught between the ends of the broken pieces of bone; when the patella and other joints are fractured), the bone has a wide separation, open fractures are evident, would debridement is necessary, or internal fixation is needed
When is staged amputation done?
when a client has severe infection and gangrene
What is open reduction internal fixation (ORIF) accomplsihed with?**
wire, nails, plate, and/or (an intramedullary rod, IM rod)