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NCLEX information review: Orthopedics

Terms in this set (15)

What are s/s of a fracture?
Pain and tenderness
Unnatural movement
Deformity (possible)
Shortening of extremities caused by muscle spasm
Crepitus (bone grating together)
Swelling
Discoloration

Worry about compartment syndrome
What is tx for a fracture?
Immobilize bone ends plus adjacent joints
Support fracture above and below site
Move extremity as little as possible
Splints help prevent fat emboli and muscle spasms
Cover open fractures with something sterile
Neurovascular checks
What are complications of a fracture?
Hypovolemic shock (pelvic fractures, crushing fractures, multiple long bone fractures)
Fat emboli (long bones, pelvic fractures, crushing injuries)
Compartment syndrome
What are the s/s of a fat embolism?
Petechiae/rash over chest
Conjunctival hemorrhage
Snow storm on CXR
What is compartment syndrome?
Increased pressure within a limited space
Fluid accumulates in tissue and impairs perfusion
Muscle becomes swollen and hard
Pt reports severe pain not relieved by pain meds
Pain disproportionate to injury
If undetected, may result in nerve damage and possible amputation
Common in forearms and quadriceps
What is the tx for compartment syndrome?
Bivalve cast
Fasciotomy
What is involved in care for a plaster cast?
Place ice packs on side of cast for 24hrs
Prevent indentations (use palms)
Keep uncovered and allow to air dry
Do not rest on hard surface or sharp edge
Rets on soft pillow
Mark breakthrough bleeding
Cover cast close to groin with plastic
Neurovascular checks
What is involved in care for a fiberglass cast?
Dry within 30 mins
Lightweight, waterproof, stronger
Higher quality XR
Allow to bear weight earlier
Difficult to mold and contour
Primarily for simple fractures
What is skin traction?
Short term to relieve muscle spasms and immobilize until surgery
Buck's
Skin assessments q3days
What is skeletal traction?
Traction is applied directly to bone with pins and wires
For prolonged time
Steinman pins, Crutchfield, Gardner-Wells tongs, Halo vest
Monitor pin sites q8hrs
What is pre-op care for total hip replacement?
Buck's traction
What is post-op care for total hip replacement?
Neurovascular checks
Monitor drains
Firm mattress
Over bed trapeze bar for upper body strength
Positioning
Neutral rotation
Extension of hip
Abduction
Isometric exercise
Trochanter roll
What are complications of a total hip replacement?
Dislocation (circulatory and nerve damage)
Shortening of leg, abnormal rotation, cannot move extremity, pain
Infection
Prophylactic antibiotics
Avascular necrosis
Immobility problems
What is immediate post-op care for amputations?
Have tourniquets at bedside
Prevent contractures with extension (prone position)
Phantom pain
What is involved in rehab for amputations?
Limb shaping for prosthesis (conical)
Toughen the stump
Can massage stump
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