Assessment and Diagnostic
Assessment
Head to toe assessment
Past medical history
Past surgical history
Current meds
Diet, activity, posture, weight, height
Types: open vs closed
Open: exposed bone through skin
Closed: no bone through skin
Casts: uses
Immobilize bone
o Prevent further injury
o Promote proper alignment
o Correct deformity
o Support and stabilize weak joint
Hip arthroplasty: assessment, postop care, complications and prevention, patient education
Postop ABC assessment
Neurovascular focused assessment
Suture/staple care
Potential drain care
Positioning
Encourage ROM
Diagnostic
CT scan: nursing implications
Check kidneys
Tumors, injuries, severe trauma to soft tissues, ligaments, and tendons
Allergies to meds and foods
Assessment, priorities of care, nursing management
6 Ps
o Pain
o Pulselessness
o Paresthesia
o Poikilothermic
o Pallor
o paralysis
Cast types
Fiberglass: dries in 5 min
Plaster: dries in 72 hours
Prevention/monitoring for complications in general
Atelectasis
Disuse
Hemorrhage
Infection
Constipation
Pain
WTE risk
Pressure ulcers
Basic emergency management and assessments
immobilization: splint to decrease nerve damage and vascular damage
assess distally: nerve and circulation
Cast care
Do: elevate, aerate, keep dry, apply ice to help with itching
Don’t: get wet, put anything in cast
Complications-- fat embolism syndrome & compartment syndrome: recognition, symptoms
fat embolism: fat molecules occlude small blood vessels
o S/S: pulmonary, neurological, petechial rash
Compartment syndrome: increased pressure within one or more compartments causing massive compromise
o S/S: deep, throbbing, unrelenting pain that is unrelieved by medications, intensifies with passive ROM
Cast Complications
Skin breakdown
o Infection
o Disuse syndrome
Muscle atrophy
Prevention: performing isometric contractions of
muscles hourly while awake
o Compartment syndrome
Recognize s/s to report to provider
Traction: types of traction and nursing management; complications and prevention/monitoring
Uses a pulling force to promote and maintain alignment
Goal: to realign bone and prevent muscle spasms
Nursing care: counter traction must be applied, weights not moved unless ordered, weights hand freely, body alignment is vital
Skin traction
o Indirect traction
o NI:
Monitor neurovascular status
Pain control
Turning and weight shifting
ROM
Skeletal traction
o Direct traction
o NI
Monitor neurovascular status
Pain control
Pin care
ROM
Turning and weight shifting