rigid mold that immobilizes an injured structure while it heals

• 3 types: cylinder, body cast, hip spica

Cast

encircles an arm/leg, leaving the fingers and toes exposed

cylinder cast

larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests

body cast

surrounds one or both legs and the trunk

• strengthened by a bar that spans a casted area b/t the legs
• trimmed open in the anal and genital areas to facilitate elimination

spica cast

How should a client w/ a spica cast be positioned while the cast dries?

feet are positioned so that they support the desired body alignment and is resting on pillows until the cast dries

How are bone fragments kept aligned for clients w/ a cast?

the cast is applied from the joint above the break to the one below it

• the joint is slightly flexed to decrease stiffness

REVIEW BOX 61-2: APPLYING A CAST

MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST

REVIEW BOX 61-2: APPLYING A CAST

MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST

How should a wet cast be kept?

• it should be kept uncovered so water can evaporate
• drying cast should be supported by pillows
• avoid using fingertips and compressing the cast on a hard surface to prevent pressure sores later. Use palm of hands instead

may be cut into cast after the cast dries

• permits direct inspection of skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing
• once this is cut, the solid piece of the cast is replaced in its original site and secured w/ adhesive tape or a roller bandage
• leaving this open may allow the skin and soft tissue to bulge through the opening

Cast windows

What are some things that may be expected after a cast removal?

What are some interventions to help with what is expected?

Things expected:

• skin may appear mottled and may be covered w/ a yellowish crust
• this residue may shed for a few days
• limb may feel light and client may report weakness/stiffness

Interventions

• regarding the skin, the client can soak in a warm bath and use lotions to help soften skin and remove debris
• regarding the weakness/stiffness: client's limb will need support
• An elastic bandage may be wrapped around the bandage and use a cane or arm sling until progressive active exercise and physical therapy help the client regain normal strength and motion

immobilizes and supports an injured body part in a functional position.

used when a musculoskeletal condition:

• does not require rigid immobilization
• causes a large degree of swelling
• requires special skin tx

the healthcare professional fits the client w/a splint and then overwraps it w/ an elastic bandage applied in a spiral mode

• this helps promote circulation and maintain the position of the splint

splint

provide support, control movement, and prevent additional injury for a more long-term use

• custom fit to each client
• nurse must provide instruction to the client and family on how to apply the brace and to administer scrupulous skincare to prevent irritation and injury

braces

REVIEW NURSING GUIDELINES 61-1

REVIEW NURSING GUIDELINES 61-1

A method for pulling structures of the musculoskeletal system

• requires countertraction that is usually supplied by the client's own weight
• used to relieve muscle spasm, align bones, and maintain immobilization

Traction

• skin traction
• skeletal traction

achieved by applying devices to the skin that indirectly affect the bones or muscles

• examples: buck and russell traction

Skin traction

REVIEW BOX 61-3: PRINCIPLES OF EFFECTIVE TRACTION

REVIEW BOX 61-3: PRINCIPLES OF EFFECTIVE TRACTION

REVIEW NURSING GUIDELINES 61-2: MANAGING THE CARE OF THE CLIENT IN TRACTION

REVIEW NURSING GUIDELINES 61-2: MANAGING THE CARE OF THE CLIENT IN TRACTION

the bone is restored to its normal position by external manipulation

• a bandage, cast, or traction then immobilizes the area
• x-rays are taken to ensure correct alignment of the bone

Closed reduction

performed in the operating room

• the bone is surgically exposed and realigned
• x-rays are taken to ensure correct alignment

Open reduction

needed to stabilize the reduced fracture

• surgeon secures the bone w/ metal screws, plates, rods, nails, or pins
• cast or other method of immobilization is then applied

Internal fixation

when the surgeon inserts metal pins into the bone or bones from the outside of the skin surface and then attaches a compression device to the pins

External fixation

since pin sites are an entry for infection, what should be monitored for?

• redness
• drainage
• tenderness

REVIEW NURSING PROCESS FOR THE CLIENT W/ A FRACTURE REDUCTION

REVIEW NURSING PROCESS FOR THE CLIENT W/ A FRACTURE REDUCTION

REVIEW NURSING GUIDELINES 61-3: PROVIDING PIN CARE

REVIEW NURSING GUIDELINES 61-3: PROVIDING PIN CARE

performed for various reasons:

• to correct a deformity
• remove a primary bone tumor
• align fractured bones (open reduction)
• replace or repair a joint
• insert a bone graft to promote bone healing
• stabilize a bone internally

Orthopedic Surgery

total reconstruction or replacement of a joint w/ an artificial joint to restore function and relieve pain

• ex. hip and knee surgery

Arthroplasty

Post-op complications for clients who've had orthopedic surgery?

• hemorrhage
• subluxation: dislocation of the joint
• infection
• thromboembolism
• avascular necrosis (death of bone tissue b/c of diminished/absent blood supply)

Depending on the type of joint replacement, what may the client be asked to do?

donate their blood preoperatively just in case it has to be used postoperatively if transfusion is required

What are very important for clients who have a knee or hip replacement surgery?

• early ambulation: goal is to have client bend the knee @ 90 degrees by discharge
• anticoagulant therapy

Pre-op nursing management care for clients undergoing orthopedic surgery

• helping the client to experience reduced pain
• continue to be active, mobile, and injury free
• practice measures to reduce the potential for post-op infection
• control anxiety at manageable levels
• understand instructions
• comprehend the procedures and rationale of post-op management

REVIEW NURSING GUIDELINES 61-4: ENSURING COMPLETE CARE FOR CLIENTS BEFORE ORTHOPEDIC SURGERY

REVIEW NURSING GUIDELINES 61-4: ENSURING COMPLETE CARE FOR CLIENTS BEFORE ORTHOPEDIC SURGERY

Post-op nursing management care for clients undergoing orthopedic surgery

• demonstration of deep breathing and coughing and use of a spirometer
• withhold aspirin before surgery to reduce risk for excessive bleeding
• monitor CBC, prothrombin time, and bleeding and clotting times to ensure that the client's ability to control bleeding is not compromised
• review pt's orders concerning turning, movement, position of extremities
• head of bed is less than 45 degrees

How should a client w/ a total hip replacement be positioned?

• have legs abducted w/ pillows or abductor cushion and extended
• need to sit in an elevated chair or on a seat raised by pillows so the flexion remains less than 90 degrees
• ice packs help to reduce pain and inflammation to the incision site
• abduction, neutral rotation, and flexion of less than 90 degrees, NO CROSSED LEGS/CROSSING @ THE FEET

REVIEW BOX 61-5: AVOIDING HIP DISLOCATION AFTER CONVENTIONAL REPLACEMENT SURGERY

REVIEW BOX 61-5: AVOIDING HIP DISLOCATION AFTER CONVENTIONAL REPLACEMENT SURGERY

REVIEW TABLE 61-2: PREVENTING POST-OP COMPLICATIONS AFTER JOINT REPLACEMENT SURGERY

REVIEW TABLE 61-2: PREVENTING POST-OP COMPLICATIONS AFTER JOINT REPLACEMENT SURGERY

TRUE OR FALSE?

if a client has pins and screws, they should be sure to let someone know before getting a MRI

TRUE

W/i 24-72 hours after orthopedic surgery, what complication may occur? (esp. hip surgery)

S/S include those a pulmonary embolus plus:

• petechial hemorrhages on the skin of chest

Fat embolus

REVIEW NURSING CARE PLAN 61-1: THE CLIENT UNDERGOING ORTHOPEDIC SURGERY

REVIEW NURSING CARE PLAN 61-1: THE CLIENT UNDERGOING ORTHOPEDIC SURGERY

REVIEW CLIENT AND FAMILY TEACHING 61-1: HOME CARE AFTER A LIMB AMPUTATION

REVIEW CLIENT AND FAMILY TEACHING 61-1: HOME CARE AFTER A LIMB AMPUTATION

the removal of a limb that may occur as a result of trauma or in an effort to control disease or disability

• lifesaving measure

amputation

the end of the residual limb/stump is temporarily open w/ no skin covering it

• usually performed in cases of infection
• skin traction is applied, and the infected area is allowed to drain
• traction is continuous

Open amputation (guillotine method)

skin flaps over the severed bone end

• return from surgery w/ a soft compression dressing or a rigid plaster shell covering the residual limb

Closed amputation

planned when a client has severe infection and gangrene

• guillotine method is used first, after infection, a more stable (closed amputation) method is done

Stage amputation

Complications post-op amputation?

• hemorrhage (keep at tourniquet at bedside)
• hematoma
• infection
• chronic osteomyelitis
• stump neuroma: formed when the cut ends of nerves become entangled in the healing scar
• phantom pain: body still thinks limb is still there causing burning, tingling, itching, throbbing for the client

what are some interventions for phantom pain?

• massage the limb

Presurgical Nursing management for clients getting amputations?

• take complete medical, drug, and allergy hx
• evaluate client for mental and emotional acceptance of procedure
• reduce pain and anxiety and support client
• explain all the routine preop preparations and reinforce what the primary provider has discussed
• answer any questions
• review post-op care (deep-breathing, coughing, positioning, routine exercises
• acknowledge client's feelings
• protect client from any additional stress
• assist w/ any daily activities
• promote adequate sleep

REVIEW NURSING PROCESS FOR THE CLIENT AFTER A LIMB AMPUTATION

REVIEW NURSING PROCESS FOR THE CLIENT AFTER A LIMB AMPUTATION

REVIEW NURSING GUIDELINES 61-5: STUMP CARE AND BANDAGING

REVIEW NURSING GUIDELINES 61-5: STUMP CARE AND BANDAGING

REVIEW CLIENT AND FAMILY TEACHING 61-2

REVIEW CLIENT AND FAMILY TEACHING 61-2

if a client reports that there affected limb w/ a cast is itching, what are some interventions to aid in relieving client?

• anti-pruritis medication (hydrocortisone and benadryl)
• cool air (never hot air)

if a client w/ a cast has cool, discolored skin and reports tingling, what should be done?

call the healthcare provider

what should be done if a client has a compound fractures to prevent infection?

protect wound w/ sterile dressing