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Timby /Smith : Introductory Medical-Surgical Nursing, 10/e

Timby /Smith : Introductory Medical-Surgical Nursing, 10/e. Chapter 61: Caring for Clients Requiring Orthopedic Treatment. Types of Casts. Cylinder Cast. Body Cast. Hip Spica Cast. Casts. Casts. Cast Composition Fiberglass; Plaster of Paris Alignment and support of the fractured area

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Timby /Smith : Introductory Medical-Surgical Nursing, 10/e

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  1. Timby/Smith : Introductory Medical-Surgical Nursing, 10/e Chapter 61: Caring for Clients Requiring Orthopedic Treatment

  2. Types of Casts Cylinder Cast Body Cast Hip Spica Cast Casts

  3. Casts • Cast Composition • Fiberglass; Plaster of Paris • Alignment and support of the fractured area • Cast material feels warm during application • Support drying cast on pillows – use palms • Cast Windows • Client reports discomfort • Wound requires regular dressing change

  4. Question Is the following statement true or false? When a limb is placed in a cast, the joint is set straight to assure bone alignment.

  5. Answer False. When a limb is placed in a cast, the cast is applied from the joint above the break to the joint below the break. The joint is slightly flexed to decrease joint stiffness.

  6. Casts • Bivalve Cast Used: • With swollen arm or limb • When being weaned from a cast • When sharp radiograph is needed • As a splint • Cast Removal • Nursing Management – Nursing Guidelines 61-1

  7. Splints, Braces • Splints • Immobilize and support an injured body part in a functional position • Braces • Provide support • Control movement • Prevent additional injury • Provide client and family education

  8. Question Is the following statement true or false? Braces provide support, control movement, and prevent additional injury.

  9. Answer True. Braces provide support, control movement, and prevent additional injury for long-term use. They are made of various materials and are custom fit to the client. Scrupulous skin care is vital to maintain skin integrity.

  10. Traction Cast Application Closed Reduction Treatment of Fractures External Fixation Open Reduction Internal Fixation Reducing Fractures

  11. Reducing Fractures Figure61-3 Examples of skin traction Figure61-6 External fixation

  12. Orthopedic Surgery • Open Reduction Internal Fixation • Buck’s extension • Nails; Intramedullary rod • Internal fixation devices • Joint Dysfunction Correction • Arthroplasty; Arthrodesis • Osteotomy; Hemiarthroplasty • Total arthroplasty

  13. Hemorrhage Loosening of cemented prosthesis Subluxation Postoperative Complications Avascular Necrosis Infection Thrombo- embolism Orthopedic Surgery Complications

  14. Orthopedic Surgery • Preoperative Nursing Management • Obtain complete history • Assess complications from previous treatment • Assist in reducing pain, risk of infection, and increasing mobility • Help control anxiety and understand instructions

  15. Orthopedic Surgery • Postoperative Nursing Management • Required demonstrations • Postsurgery devices • Reduce risk for excessive bleeding • Review physician orders • Flexion of CPM devices and movement • Help reduce pain and inflammation • Prevent postoperative complications

  16. Orthopedic Surgery • Client and Family Teaching • Support system after discharge • Explore the kinds of assistance needed • Modifications needed in the home environment • Information about home care • Referral to a home healthcare agency • Printed discharge instructions • Activity; PT; Symptoms to report

  17. Amputation • Etiology • Amputation rationale • Medical, Surgical Management • Treatment for disorder influencing healing • Level at which limb is amputated • Amputation methods: Open (guillotine); Closed (flap) Figure61-8

  18. Types of prostheses Shoulder harness, cables, and hook Semifunctioning cosmetic hand Myoelectricarm Amputation • Medical, Surgical Management (Cont’d) • Arm amputation • Leg amputation • Attachment of temporary prosthesis to plaster shell • Custom-made conventional prosthesis

  19. Postoperative Complications • Immediate Complications • Hematoma • Hemorrhage • Infection • Pain • Late Complications • Chronic Osteomyelitis • Causalgia • Phantom Limb • Phantom Pain Amputation • Medical, Surgical Management (Cont’d) • Complications

  20. Amputation • Medical, Surgical Management (Cont’d) • Phantom limb; Phantom pain • Potential phenomenon • Physiologic response • Rehabilitation • Factors influencing amputee success • Maintain realistic expectations • Nursing Management

  21. End of Presentation

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