Nursing for MS 3

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Nursing for MS 3
2015-08-29 20:14:29

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  1. Fractures
    • complete or incomplete disruption of the continiuty of the bone structure
    • adjacent structures could also be involved
    • body organs can be injured
    • causes:
    • trauma, disease process- advanced osteoporosis, malignancy
  2. types of fractures
    • video watch
    • reveiw 2084-2085
    • review open v close
    • review complete v incomplete
  3. Diagnoses of fracture
    • based of PE- subjective v objective
    • x-ray
    • MRI
  4. s/s of fractures
    • pain (localized)- mus spasms (this is why we use traction), guarding behaviors
    • lose of function- inability to bear weight
    • deformity- displacement, rotation of fragments
    • shortening in long bones
    • crepitus- crumbling sensation
    • localized edema and ecchymosis
    • neurovascular changes- 5 P's
    • - pain, paralysis, parathensias, pallor (circulatory perfusion, paralysis), pulselessness (pedal pulses)
  5. Emergency management fractures
    • Immobilize the body part
    • splinting: joints distal and proximal to the suspected fracture site must be supported and immobilized
    • assess neurovascular before and after splinting
    • open fracture: cover with sterile dressing to prevent contamination
    • do not attempt to reduce the fracture
  6. emergency management fracture 2
    • control external bleeding
    • apply ice (to reduce imflammation)
    • emotional support (fear)
    • assess complications
    • - hemorrhage- narrow pulse pressure (ie normal bp 120/80 pulse press is 40, but if bp drops the pulse pressure goes down if higher than 50 there is a cardiac problem)
    • - hypovolemia shock- blood is moving from intravascular to extravascular. blood is shifting- hr tachy, bp low, cardiac out low, incr rr,- give normal saline
    • - neurovascular function- 5 p's
    • - compartment syndrome
  7. medical management fracturew
    • Goals:
    • anatomic alignment of bone fragments (reduction)
    • immobilzation to maintain realignment
    • restoration of function
    • what is reduction
    • reduction is a medical procedure to restore fracture or dislocation to the correct alignment
  8. Fracture reduction- medical management
    • restoration of the fracture fragments to anatomic alignment and position
    • usually done as soon as possible
    • specific method selected depends on the nature of the fracture, pt's status
    • close reduction and open reduction
  9. closed reduction
    • no surgery
    • through manipulation and manual traction
    • use of cast splint may also be pinning
    • goal: maintains the reduction and stabilizes the extremity for bone healing
    • educate and support pt prior to procedure
    • pay attention to protocol but assess area so move things for u to look at it. check for sensation, CSM, PP, cap refill, temp, any problem with this u should say something. if u notice too much swelling, hurting to much, cant move toes- 
    • bivalve: cut both sides of cast bc it could be compartment syndrome
    • look at pinning video
  10. closed reduction medical management
    • post procedure
    • assessment:
    • VS, abdominal
    • Neurovascular, neurological- Mental status changes- worry about fat embolism
    • pain- complaining of severe pain after medicated is a red flag
    • skin- swelling, bruise, abrasions, bleeding
    • educate pt- cast, splint care and complication
    • brunner- chart 67-1 67-2
  11. Open reduction
    • surgical approach
    • fracture fragments are aligned
    • use of pins wires, screws, plates, nails or rods
    • - internal fixation
    • - external fixation
  12. internal fixation v external fixation
    • internal- fixing the bone from the inside with nails and pins
    • external- fixing the none from the outside-
    • clean pins, no swelling at the ankles, no drainage no odor)
  13. post op care open reduction
    • after reduction, immobilization of bone must occur-
    • - external fixation devices
    • - internal fixation devicess=
    • - splints, cast, bandages
    • - traction- skin and skeletal
    • review care with pt w/traction, cast, fixation devices 2024- 2036
  14. post op care reduction
    • accurate assessment
    • - vs, neurovascular check
    • - assess drainage (color odor), bleeding
    • - assess drainage systems- hemovac drain, output, content xteristics
    • - assess infection
  15. Post op care reduction
    • pain management- pre emptive (b4 procedure to be comfy)
    • PCA- assess rr q2hrs
    • muscle relaxants- flexeril (review pharm notes)- makes u drowsy- no driving
    • non pharm- distraction (tv shows ect), ice area
  16. post op care reduction
    • Postitioning- helps with blood flow- healing, prevent skin breakdown, 
    • - ROM, progressive activity, trapeze, PT
    • - assistive devices - correct usage
    • - elevate extremitity - reduce edema
    • assess bowel and bladder- listen to bowel sounds
    • - assess constipation- cause of pain meds, immobility, 
    • - stool softner, high fiber, bulk diet, push fluids
    • - assess urinary retention (avoid foley: risk of infection)
  17. post op reduction
    • assess skin breakdown
    • nutrition
    • - push fluids )2-3Lday
    • - encourage proteins,vit c, d, calcium
    • assess complications related to immobility
    • review lecture from first yr (immobility)
    • encourage, cough, deep breathing, IS,ROM< teds
    • meds: lovenox dec thrombus- dvt- pe which u need to prevent
  18. post op reduction
    • pt teaching- not just them but involve the family as much as possible
    • adjunct measures to inc bone healing
    • - electric bone stimulation, eletromagnetic pulsation- helps to enhance bone healing
    • - weight bearing if approriate
    • emotional support
  19. other managements of the pt with open reduction- fracture- dont need to memerize
    • continue with previous care/assessments
    • assess for infection
    • IV antibiotics
    • tetanus injection
    • woud irrigation, debridement
    • - negative pressure wound therapy- wound closure delay
  20. negative pressure wound system- wound too big not healing weell
    • purpose:
    • reduces edema
    • inc local blood flow
    • facilities granulation tissue growth
    • candidates:
    • wounds too large to close surgically
    • wounds that do not have adequate soft tissue for closure
    • wound with external fixation device
    • large infected wounds 
    • always check the pressure and make sure if matches what is in the chart
    • check area no incr redness, content of drainage, no blood clot, not changed daily maybe three times week, wiggly toes, incr swelling, complaining of pain (pay attention)