introduction to the orthopedic chapter in timbys .pptx

introduction to the orthopedic chapter in timbys

1. Timby’s Introductory Medical-Surgical Nursing, 13e Chapter 61: Caring for Clients Requiring Orthopedic Treatment

2. Types of Casts Cylinder Body Hip spica Others (see Box 61-1)

3. Casts #1 Cast Composition Fiberglass; plaster of paris Alignment and support of the fractured area See Box 61-2 Cast material feels warm during application Support drying cast on pillows

4. Casts #1 Cast Windows Client reports discomfort Wound requires regular dressing change

5. Question #1 Is the following statement true or false? When a limb is placed in a cast, the joint is set straight to assure bone alignment.

6. Answer to Question #1 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.

7. Casts #2 Bivalve cast is used With swollen arm or limb When being weaned from a cast When sharp radiograph is needed As a splint

8. Casts #2 Cast Removal Nursing Management (Nursing Guidelines 61-1)

9. Splints and Braces Splints Immobilize and support an injured body part in a functional position

10. Splints and Braces Braces Provide support Control movement Prevent additional injury Provide client and family education

11. Question #2 Is the following statement true or false? Braces provide support, control movement, and prevent additional injury.

12. Answer to Question #2 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.

13. Reducing Fractures: Traction Management Traction (Box 61-3 and Nursing Guidelines 62-1) Closed reduction Open reduction

14. Reducing Fractures: Traction Management Internal fixation External fixation (Nursing Guidelines 61-3)

15. Orthopedic Surgery #1 Open Reduction Internal Fixation Buck’s extension Nails; intramedullary rod Internal fixation devices

16. Orthopedic Surgery #1 Joint Dysfunction Correction (Box 61-4) Arthroplasty; arthrodesis Osteotomy; hemiarthroplasty Total arthroplasty

17. Orthopedic Surgery #2 Minimally invasive vs. conventional joint replacement Incision/exposure OR time/blood loss Pain/recovery Risks Selection

18. Orthopedic Surgery #2 Preoperative Nursing Management (see Nursing Guidelines 61-4) Obtain complete history Assess complications from previous treatment Assist in reducing pain, risk of infection, and increasing mobility Help control anxiety and understand instructions

19. Orthopedic Surgery #3 Postoperative Nursing Management Required demonstrations Postsurgery devices Reduce risk for excessive bleeding

20. Orthopedic Surgery #3 Postoperative Nursing Management Review primary provider’s orders Flexion of CPM devices and movement Help reduce pain and inflammation Prevent postoperative complications

21. Orthopedic Surgery #4 See Client and Family Teaching 61-1 Support system after discharge Explore the kinds of assistance needed Modifications needed in the home environment Information about home care Referral to a home health care agency Printed discharge instructions Activity, PT, symptoms to report

22. 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° See Box 61-5

23. 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.

24. 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) Arm amputation Leg amputation Attachment of temporary prosthesis to plaster shell Custom-made conventional prosthesis

25. Amputation Medical and Surgical Management—(cont.) Phantom limb; phantom pain Potential phenomenon Physiologic response Rehabilitation Factors influencing amputee success Maintain realistic expectations Nursing Management See Evidence-Based Practice 61-1

26. Question #3 By the time of discharge from the hospital, a client with a knee replacement should bend the knee how many degrees? A) 30° B) 45° C) 60° D) 90°

27. Answer to Question #3 D) 90° Rationale: The goal is for the client to have the ability to bend the knee 90° by discharge.