Timby /Smith : Introductory Medical-Surgical Nursing, 10/e

1. Timby/Smith : Introductory Medical-Surgical Nursing, 10/e Chapter 61: Caring for Clients Requiring Orthopedic Treatment 01/24 Pg 969

2. Words to Know [12] • Arthroplasty Avascular Necrosis Brace • Cast Closed Reduction • External Fixation Internal Fixation • Open Reduction Prosthesis • Splint Subluxation • Traction 02/24 Pg 969

3. Learning ObjectivesOn completion of this chapter, you will be able to • Differentiate types of casts. • Discuss the nursing management for a client with a cast • State the reasons for using splints or braces. • Identify the principles for maintaining traction and describe nursing care for the client in traction. • Differentiate between closed reduction and open reduction and between internal fixation and external fixation. • Describe nursing care for the client with a fracture reduction. 03/24 Pg 969

4. Learning ObjectivesOn completion of this chapter, you will be able to • Identify the reasons for performing orthopedic surgery. • Discuss the nursing management for a client undergoing orthopedic surgery. • Describe the positioning precautions after a conventional total hip replacement. • Explain the nursing needs of the client undergoing total knee replacement. • Discuss amputation, including reasons it may be performed and appropriate nursing management of the client 04/24 Pg 969

5. Types of Casts Cylinder Cast Body Cast Hip Spica Cast Casts 05/24 Pg 969

6. Casts • Cast Composition • Fiberglas; Plaster of Paris • Alignment and support of the fractured area • Cast material feels warm during application • Support drying cast on pillows [Palms] • Cast Windows [If] • Client reports discomfort • Wound requires regular dressing change 06/24 Pg 971

7. Question Is the following statement true or false? When a limb is placed in a cast, the joint is set straight to assure bone alignment. [NCLEX TYPE] 07/24 Pg 969

8. Answer False. 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. The Reduction aligns the bone ends 08/24 Pg 969

9. Casts • Bivalve Cast Used: • With swollen arm or limb • When being weaned from a cast • When sharp radiograph is needed • As a splint • Cast Removal [Vibrating saw] • Nursing Management 09/24 Pg 971

10. Splints, Braces • Splints • Immobilize and support an injured body part in a functional position • Braces • Provide support • Control movement • Prevent additional injury • Provide client and family education 10/24 Pg 971

11. Question Is the following statement true or false? Braces provide support, control movement, and prevent additional injury. 11/24 Pg 971

12. Answer 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. 12/24 Pg 971

13. Traction Cast Application Closed Reduction Treatment of Fractures External Fixation Open Reduction Internal Fixation Reducing Fractures 13/24 Pg 971

14. Reducing Fractures 14/24 Pg 973 Figure61-3 Examples of skin traction Figure61-6 External fixation

15. Orthopedic Surgery • Open Reduction Internal Fixation • Buck’s extension • Nails; Intramedullary rod • Internal fixation devices • Joint Dysfunction Correction • Arthroplasty; Arthrodesis • Osteotomy; Hemiarthroplasty • Total arthroplasty 15/24 Pg 973

16. Hemorrhage Loosening of cemented prosthesis Subluxation Postoperative Complications Avascular Necrosis Infection Thrombo- embolism Orthopedic Surgery Complications 16/24 Pg 979

17. Orthopedic Surgery • Preoperative Nursing Management • Obtain complete history • Assess complications from previous treatment • Assist in reducing pain, risk of infection, and increasing mobility • Help control anxiety and understand instructions 17/24 Pg 980

18. Orthopedic Surgery • Postoperative Nursing Management • Required demonstrations • Postsurgery devices • Reduce risk for excessive bleeding • Review physician orders • Flexion of CPM devices and movement • Help reduce pain and inflammation • Prevent postoperative complications 18/24 Pg 980

19. Orthopedic Surgery • Client and Family Teaching • Support system after discharge • Explore the kinds of assistance needed • Modifications needed in the home environment • Information about home care • Referral to a home healthcare agency • Printed discharge instructions • Activity; PT; Symptoms to report 19/24 Pg 980-981

20. Amputation • Etiology • Amputation rationale • Medical, Surgical Management • Treatment for disorder influencing healing • Level at which limb is amputated • Amputation methods: Open (guillotine); Closed (flap) 20/24 Pg 984 Figure61-8

21. Types of prostheses Shoulder harness, cables, and hook Semifunctioning cosmetic hand Myoelectricarm Amputation 21/24 Pg 984 • Medical, Surgical Management (Cont’d) • Arm amputation • Leg amputation • Attachment of temporary prosthesis to plaster shell • Custom-made conventional prosthesis

22. Postoperative Complications • Immediate Complications • Hematoma • Hemorrhage • Infection • Pain • Late Complications • Chronic Osteomyelitis • Causalgia • Phantom Limb • Phantom Pain Amputation • Medical, Surgical Management (Cont’d) • Complications 22/24 Pg 985

23. Amputation 23/24 Pg 985 • Medical, Surgical Management (Cont’d) • Phantom limb; Phantom pain • Potential phenomenon • Physiologic response • Rehabilitation • Factors influencing amputee success • Maintain realistic expectations • Nursing Management

24. NCLEX Questions Pg 967-968 End of Presentation By: P.K. Williams, RN pkwilliams@DNI.edu25/25 Pg 988