nursing for MS 4

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nursing for MS 4
2015-08-30 12:50:05

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  1. Hip Fracture
    • Fracture of proximal third of the femur
    • two major types of hip fracture:
    • Intracapsular:
    • - femur neck- blood vessels (major blood supply)
    • - caused by osteoporosis or minor trauma
    • - leads to avascular necrosis AVN can occur
    • Extracapsular:
    • - outside of the joint capsule
    • - trochanteric and subtrochanteric
    • - cause by fall or trauma
    • - heal more rapidly due to good blood supply
  2. S/S of hip fracture
    • external rotation
    • shortening of the affected extremity
    • pain and tenderness
    • muscle spasm- if u can control this then u can control the pain
    • ecchymosis
    • dx: PE and x-ray
  3. Medical management of hip fracture
    • accurate assessments
    • assess labs- cbc w/diff, esr, 
    • buck's traction
    • - skin traction- short term use
    • - immobilize fracture b4 surgery, control muscle spasms, and reduce pain
    • - careful assessment of skin breakdown, CSM, neuro (fat embolism, DVT, if notice confused pt, restlessness, tachyapnea)
    • - accurate management of traction
  4. Buck's traction
    • skin traction to the lower legs
    • traction: application of a pulling force to part of the body
    • - prescribed wt usually is 5-8lbs to the rope
    • to apply a conteraction to the traction- make sure pt is flat on the bed
    • assessments: skin, neurovascular, CSM
    • review care of pt with buck's traction (brunner 13th ed 1112-1115
    • pain management
    • pt teaching/support
    • mobility, positioning
  5. Surgical management of hip fracture
    • pre-op assessments- labs platelets added
    • Intracapsular fractures
    • - hemiarthroplasty (replacement of femoral head)
    • Extracapsular fractures:
    • - open/closed reduction with screws, plates and/or rods, pins
    • -better the reduction, the better the change of healing
  6. What ORIF surgery
    open reduction internal fraction refers to a surgical procedure to fix a severe bone fracture or break. open reduction means surgery is needed to realign the none fracture into the normal position. internal fixation refers to the steel rods, screws or plates used to keep the bone fracture stabe in order to heal the right way to help prevent infection
  7. Post op care open reduction internal fixation
    • 1. accurate assessment (neuro checks)
    • 2. assessment of pain and managements
    • - pre-emptive pain control
    • - PCA
  8. post op ORIF 3
    • 3. positioning/mobility
    • - keep pillow b/w lefs (log roll w/pillow between legs) to keep the affected leg/hips in adbucted position- neutral hip rotation
    • - encourage self care, ROM of unaffected extremities, trapeze bar
    • - PT/transfers/assistive device
    • - hip precautions for fermoral head prostheis (next slide
  9. hip precautions for femoral head replacement
    • abduction pillow, extended
    • never flex hip more than 90 degrees
    • do not cross legs
    • utilize high seat chairs, raised toilet seats
    • hips need to be higher than the knee
    • avoid adduction, external rotation, hyperextension and acute flexion
  10. Post op ORIF 4-6
    • 4.assess CSM and neurovascular
    • - assess pain, edema
    • 5. assess hemorrhage
    • - assess vs, cbc, dressing, wounds, drains
    • 6. assess infection (tissue trauma vs, UTI vs wound infection)
    • -  Assess vs, cbc, incision, wound, drains, d/c foley (pay attention to when this pt urinate)
  11. Post op ORIP 7
    • Assess DVT
    • - assess s/s risk factos
    • - avoid popiteal pressure- bc can affect the blood
    • - change position q 2hr/prn
    • - apply sequential sockings/teds
    • administer heparin, lovenox
  12. post op ORIF 8
    • assess skin break down
    • - assess pressure points- ulcer
    • - utilize special care matress- helps with circulation, helps prevent skin breakdown air mattress
    • - reposition pt, skin care
    • - skin care policy (braden scale)
  13. post op care orif 9-10
    • 9. assess respiratory complications
    • - assess LS, o2 star, vs
    • - encourage- cough, deep breathing, IS, mobility
    • - oxygen as needed
    • 10. assess bladder
    • - assess i&o
    • - avoid foley cath, use bladder scan
  14. post op care orif 11-12
    • 11. assess GI
    • assess risk for constipation (usually day 3-4)
    • 12. pt support/teaching
    • rehab/referrals, outpt, home needs
  15. complications orif
    • post op complication: dvt, infection, skin breakdown
    • hip displacement
    • - extremity shortening
    • - internal/external rotation
    • - increased pain
    • - unable to move extremity
    • - popping sensation, lump in buttocks
  16. Pelvic fractures
    • pelvis: sacrum, ileum, pubis and ischium bones
    • causes: falls, trauma, MVA
    • effect of trauma depends on level of force
    • less force for stable fractures
    • great for for unstable fractures
    • one of the highest mortality rate due to complications- bleeding
    • two types- stable and unstable
  17. Stable pelvis fracture
    • single fracture with ligaments intact holding the area
    • this area is very vascular
    • treatment: conservative- cancellous bone- leave it and let it heal
    • bed rest:
    • - log roll
    • - activity as directed by MD
    • - walker, crutches, pt
    • pain management
    • fluids, dietary fiber
    • interventions to decre the risk of dvt, constipation, pneumonia, skin breakdown
  18. Unstable Pelvic fracture
    • involves rotation and instability, may also be disruption of the ligaments (open book type)
    • treatment:
    • immediate intervention- ed
    • stabilize and immobilize the pelvis
    • control bleeding (worst thing that happens), laceration of major blood vessel, embolization using interventional radiology prior to surgery (this helps to find where they blood is this is done before surgery so pt doesn't bleed to death)
    • careful assessment and movement of the pt
    • avoid indwelling cath and do not catherize if urinary injury is suspected (use subracath)
    • skeletal traction (last longer as suppose to skin traction which is short term), spica casts
    • surgical candidates
  19. spica cast
    • nursing management
    • reposition pt q 2hrs to relieve pressure and allow cast to dry
    • prone twice daily if tolerated for postural drainage
    • psychological- anxiety
    • physiological- dec GI, gas abd disconfort, abd distention, n, v- u can't avoid the abd
    • - decompression (NGT to suction)
  20. s/s of pelvic fracture
    • ecchymosis of pelvis and abd tenderness, local edema, numbness/tingling (compression of the nerve- get someone right aways), unusual pelvic mobility, inability to bear weight
    • assess bladder bowel assess
    • assess lower extremities (neuro checks)
  21. Dx of pelvic fractureq
    • urinalysis- how much blood pt is losing thru urine
    • pregnancy test- child bearing age (bc of radiation exposure)
    • hg/hct
    • x-ray
    • ct of pelvis
    • us
    • look at video for management
  22. management of pelvic fraction
    • initial
    • accurate and immediate assessment
    • positioning: immobilize and stablize
    • control bleeding, receive blood products
    • assess neurovascula complications, bleeding, shock, bladder, abdominal area
  23. Immediate complication of pelvic fracture
    • bleeding/hemorrhage
    • laceration of blood vessels
    • 1st 24hr hours: greatest bleeding, but risk continues leading to shock
    • bleeding/shock most serious complication
  24. immediate complication of pelvic fracture shock
    • shock:
    • related to blood loss
    • refer to s/s and treatment of shock
    • other complication: laceration of the bladder (urine retention), urethra, colon
    • post complications: infection, pneumonia, dvt, pe
  25. fracture healing review
    • hematoma
    • granulation tissue
    • cellus formation 
    • ossification
    • consolidation
    • remodeling
    • not for the test
  26. facotrs affecting frcture healing
    • age- younger heal faster
    • site of fracture- 
    • displacement of the fracture
    • blood supply to the bone
    • infection
    • reduction and immobilization
    • nutrition
    • weight bearing
  27. general complications of fracture
    • direct
    • - involve bone
    • - bone infection, bone union, 
    • indirect
    • - involves blood vessels and nerves
  28. general complication of fracture 1
    • 1. infection
    • open fracture and soft tissue have high incidences
    • most common staph and strept (know organism to know which antibiotic given)
    • assess for infection (local or systemic)
    • - assess osteomyelitis
    • pt teaching
  29. general complication of fracture pneumonia atelectasis
    • pneumonia and atelctaiss
    • encourage c&db and IS
    • lung sounds
    • early mobilization if possible, ROM