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What are bunions and what is the treatment?
- Bony enlargement of a joint of the foot caused by ill-fitting shoes
- Joint then enlarges due to body weight on ball of foot
- Enlargement leads to hallux vargus (lateral drift of big toe resulting in overlapping toes)
- Bunionectomy involves removal of bony growth and realignment with pins
What are some negative effects of high heal shows?
- Misalignment of the spine
- Shortening of the achilles tendon
- Hammer Toes
- Hallus Vargus
- Morton's neuroma (small tumor in digital nerve of the foot)
What are the different types of fractures?
- Complete- break across entire width
- Incomplete- break only through park of the bone
- Open/compound & Closed
- Pathologic- spontaneous fracture occurring after the bone was weakened by disease
- Compression-often occurs in spine due to loading pressure on long axis
- Displaced & Non Displaced
- Impacted (think CTs knee)
- Green stick
What is ACS? What are the causes and what risks/complications are involved?
- Acute Compartment Syndrome
- Hemorrhage, edema, tight cast causes pain and edema compressing the nerves and vessels inside the muscle fascia
- Results in pain, nerve damage, necrosis, infection, and possible amputation
- Risk for Myoglobinuric syndrome, where renal failure is caused by muscle protein in the blood clogs the renal tubes
What assessment should be done to assess for ACS? What is the treatment?
- CMS checks compared to contralateral side
- Skin color, pulses, cap refill, temperature distal to site
- Numbness, tingling, sensation, pain
- Movement of fingers, toes
- Treatment is a fasciotomy to relieve pressure
What is FES? What are the s/s?
- Fat Embolism Syndrome
- Results from fat globules from long bone fracture circulating in blood
- Usually occurs within 2 days of long bone surgery with gradual onset
- First S/S is altered mental status r/t decreased O2
- Dyspnea and chest pain
- Petechia on upper trunk is a late sign
- *resulting PE can be deadly
What is a delayed union?
- fracture that does not heal within 6 mo
- Causes pain, dysformation and immobility
What is the emergency care of a fracture?
- CAB and call 911
- Quick assessment for other injuries and assess affected area
- Remove clothing and jewelry to prevent restriction during swelling
- Apply direct pressure
- CMS checks
- Splint and dressing
What is the difference between a closed reduction and an open reduction?
- Closed reduction is done with manual traction to place bones back together
- General Anesthesia may be used
- Open Reduction Internal Fixation (ORIF) is an open surgery to reduce fracture and apply plates and screws, which can be removed after healing
What nursing care should be done for casts? What is important to remember about plaster casts?
- CMS checks distal to cast to assess for compartment syndrome
- Assess for infection under cast
- Bivalve cast may be used near end (open on sides and held with elastic wrap to splint)
- Elevate the cast above heart to reduce swelling
- Apply ice to cast for first 24-48 hrs to reduce swelling
- Plaster casts tak 1-3 days to air dry, cannot get wet, and must be held with palms when wet
What is bucks traction?
- Skin traction that pulls to fixate and align bone ends prior to surgery. Like a boot that pulls with weight over end of bed
- Can also be used for candidates who cannot have surgery or to treat muscle spasms prior to surgery
- Add 5-10lb weight and keep weight off floor
Describe External Fixation Devices
- Pins go directly through skin to bone for fixation of limbs, pelvis
- Done under general anesthesia
- Frame can be adjusted as needed by MD
- Allows to direct site of skin and pin sites
- Site should drain clear fluid for 3 days
- Pain management is important and starts in the PACU
- Risk for disturbed body image
What is a bone graft?
- Cadaveric bone or autograft bone from pelvis used to supplement bone ends, lengthen bones, or replace comminuted bone
- Graft is wired or internally fixated to surrounding bone
What are the different kinds of hip fractures? What is the treatment?
- Classified by location
- Intracapsular: inside joint capsule. Capital, subcapital, femoral, femoral neck
- Extracapsular:outside joint capsule. Intertrochanteric, subtrochanteric
- Treated with Open Reduction Internal Fixation
- Bedrest for clients who cannot tolerate surgery
- fixation may be used prior to surgery to prevent muscle tremors
What are the risk factors for a broken hip? What is the greatest cause?
- Falls are the biggest cause, with osteoporosis being the greatest risk factor
- Poor vision, hearing, poor lighting, uneven surfaces
- Weakened gait, balance, or muscle strength
- Loose carpets, throw rugs, and clutter in the house
What s/s are found with a hip fracture? What is the diagnostic test used for diagnosis?
- Pain over upper thigh or groin
- Affected leg shorter than unaffected leg
- External rotation of affected leg
- Diagnosis made by xray
What are the different kinds of amputations?
- Chopart- mid foot amputation
- Syme- foot removed, ankle remains
- Below the Knee Amputation (BKA)
- Above the Knee Amputation (AKA)
- Hip Disarticulation- removal of the hip joint, more common in younger pts as a last resort for cancer, osteomyelitis, or trauma
What nursing considerations need to be taken preop to an amputation?
- Grieving for anticipated loss of limb
- At risk for systemic infection, reduce risks
- Routine preop consents and procedures for surgery
What nursing considerations need to be made for postop of an amputation?
- Assess for Hemorrhage
- Assess for Infection at site and provide adequate wound care
- Assess for phantom limb pain (PLP)
- PLP can be treated with tricyclic antidepressants, antiepileptics, narcotics, NMDA nerve blocks, mirror therapy, virtual therapy