Brunner Chpt 41: Musculoskeletal Care Modalities

The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon.

After surgery for a THA the patient should not be placed on which side?

Encircles the trunk

Explain a body cast.

A body jacket that encloses the trunk, shoulder, and elbow.

Explain a shoulder spica cast.

A short- or long-leg cast reinforced for strength.

Explain a walking cast.

This type of traction supports the affected extremity off the bed and allows for some patient movement without disruption of the line of pull. With this traction, the countertraction is produced by devices such as slings or splints.

Explain balanced suspension traction.

within 30 minutes of application.

Fiberglass casts reach full rigidity in how long?

Footdrop. (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating.

Injury to the peroneal nerve as a result of pressure is a cause of ___________________________.

Epoetin alfa

Patient who are scheduled to have a joint replacement may be put on what medication preoperatively to increase hemoglobin?

90 degrees.

The hip should never be flexed more than ___________________.

Noting bowel sounds every 4 to 8 hours, and reports abdominal discomfort and distention, nausea, and vomiting to the primary provider.

The nurse monitors the patient in a large body cast for potential physiologic cast syndrome by doing what?

Long arm cast, or long arm thumb spica.

This is an example of what kind of cast?

Long leg cast.

This is an example of what kind of cast?

Short leg cast.

This is an example of what kind of cast?

Dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia.

What are some manifestations of compartment syndrome?

Dislocation of the hip prosthesis, excessive wound drainage, VTE, infection, and heel pressure ulcer.

What are some possible complications following a total hip arthroplasty (THA)?

Prevents dislocation of hip prosthesis.

What is the purpose of using an abduction pillow, neutral rotation, and limited flexion after a THA?

Only the palms of the hands should be used so that indentations in the cast may be prevented.

When moving a patient with a wet plaster class what part of her hands should the nurse use to handle the cast?

To prevent bony fragments from moving against one another, the patient should not turn from side to side; however, the patient may shift position slightly with assistance.

A patient in Buck's traction asks if it is OK for her to turn on her side. What should the nurses response be?

Encloses the trunk and a lower extremity. A double hip spica cast includes both legs.

Explain a hip spica cast.

Extends from the axillary fold to the proximal palmar crease. The elbow usually is immobilized at a right angle.

Explain a long arm cast.

Extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

Explain a long leg cast.

Extends from below the elbow to the palmar crease, secured around the base of the thumb. If the thumb is included, it is known as a thumb spica or gauntlet cast.

Explain a short arm cast.

Extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position.

Explain a short leg cast.

This type of traction applies the pulling force in a straight line with the body part resting on the bed. Buck's extension traction is an example of straight traction.

Explain straight or running traction, and give an example.

At least 4 months.

How long after surgery should hip precautions be followed? (No bending at the waist or crossing the legs)

24-72 hours.

How long do plaster casts take to dry post application?

At least every hour for the first 24 hours and every 1 to 4 hours thereafter.

How often should neurovascular assessments take place?

Short arm cast.

This is an example of what kind of cast/.

Double hip spica cast.

This is an example of what kind of cast?

Isometric exercises. This should be performed hourly while the patient is awake.

To prevent disuse syndrome _______________ exercise must be performed. Examples might include: "push down" the knee or to "make a fist."

• Keep the knees apart at all times. • Put a pillow between the legs when sleeping. • Never cross the legs when seated. • Avoid 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. • Do not flex the hip to put on clothing such as pants, stockings, socks, or shoes.

What are some methods for avoiding a hip dislocation after THA?

pain, pallor, pulselessness, paresthesia, and paralysis.

What are the "five Ps" indicative of symptoms of neurovascular compromise?

assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. While assessing motion, the nurse should note any weakness or paralysis of the injured body part. While assessing sensation, the nurse monitors for paresthesia (numbness or tingling) or absence of feeling in the affected extremity, which could indicate nerve damage.

What does a neurovascular assessment include?

Pain that occurs or intensifies with passive range of motion.

What is a hallmark sign of compartment syndrome?

200-500 ml in first 24 hours. by 48 hours postoperatively, the total drainage in 8 hours usually decreases to 30 mL or less.

What is a normal amount of drainage in a portable suction device after surgery?

Assessment and prevention of neurovascular dysfunction or compromise of the affected extremity.

What is the main nursing concern following the application of an immobilization device?

No more than 2 to 3.5 kg (4.5 to 8 lb).

What is the maximum amount of traction that can be used on an extremity?

The formation of a pressure ulcer.

What might be occurring when a patient reports a burning sensation under the cast?

• Traction must be continuous to be effective in reducing and immobilizing fractures. • Skeletal traction is never interrupted. • Weights are not removed unless intermittent traction is prescribed. • Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated. • The patient must be in good body alignment in the center of the bed when traction is applied. • Ropes must be unobstructed. • Weights must hang freely and not rest on the bed or floor. • Knots in the rope or the footplate must not touch the pulley or the foot of the bed.

What principles of effective traction must the nurse keep in mind when caring for a patient with traction?

extremity shortens, internally or externally rotated, severe hip pain, patient unable to move extremity.

What signs might indicate a dislocated hip?

Within 15 to 30 minutes of the application and then every 1 to 2 hours.

While a patient is in skin traction how often should the nurse assess circulation of the foot?

It should be supported on a firm and smooth surface, it should not be placed on a hard surface or one with sharp edges. If elevation is requested to reduce swelling, a cloth-covered pillow is preferred to one covered in plastic.

While a plaster cast is drying what kind of surface should is be placed on?

Severe burns, because the heat generated by the chemical reaction cannot escape.

While the plaster cast is being applied, and after, the nurse must watch for what serious reaction?

The nurse assesses each pin site at least every 8 to 12 hours for redness, swelling, pain around the pin sites, warmth, and purulent drainage, because these are the most common indicators of pin site infections.

With an external fixation device how often should the nurse check the pin sites for signs of infection?

Call the doctor. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents.

Your patient has a long leg cast. You have already given the prescribed analgesic agents, raised the extremity, and used ice packs, but the patient says the pain is relentless and not going away. What should you do?