Orthopedic Nursing. Lecture Notes @ Philipine Orthopedic Center 4vi2a

NURSING CARE FOR BST (BALANCED SKELETAL TRACTION) 1. 2. 3. 4.

Assess the patient’s level of consciousness and understanding. Provision of general comfort. Skin care Perineal Care POTENTIAL COMPLICATIONS IN BST (BALANCED SKELETAL TRACTION)

1. Bed sores (advise the patient to turn sides, maintain the linens to be dry and clean as well as free from wrinkles, etc) 2. Pneumonia (encourage deep breathing exercises to the patient in order to promote lung expansion, back tapping to promote loosen the bronchial secretions) 3. Urinary Tract Infections (advise the patient to have a regular voiding, good perineal care and to increase fluid intake) 4. Constipation (advise to increase fluid intake, high fiber diet and have a regular bowel movement) 5. Contractures and stiffness of the muscles (encourage to have a contraction and relaxation of the quadricep muscles, foot pedal exercises/dorsiflexion of the feet) 6. Infection at the Steinmann pin sites FORMAT FOR CASE ANALYSIS Name: Age: Address: Status: Date itted: Educational Attainment: Physician incharge: Case number: Diagnosis: Physical Assessment: Nursing History (present health history, past health history, family history): Pathophysiology (including the anatomy and physiology of the affected part) Diagnostic procedures: Medical Management: Surgical Management: Discharge Plan:

James M. Alo, RN, MAN, MAPsycho, Ph.D

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FORMAT FOR REPORTING (ORAL AND WRITTEN) Definition/alternative names Causative agent Causative factors Clinical manifestations Pathognomonic signs Pathophysiology Anatomy and physiology (affected part) Diagnostic procedures Medical management Surgical management Nursing care HARDWARE (Purpose: to put bones in good alignment without conformity and infection and also to reduce fracture through external and internal fixators) IMPLANTS INTERNAL FIXATORS: Hip prosthesis Spacer with antibiotic Hip prosthesis and acetabular cup

INDICATION

SURGERY

For fracture of the femoral head and neck For infected hip prosthesis

Partial hip replacement arthroplasty Partial hip replacement arthroplasty Total hip replacement arthroplasty

Cerclage wire Antibiotic beads

Fracture of femoral head, femoral neck including the acetabulum For osteoarthritis in the kneet Fracture of the patella Osteomyelitis

Luque rod/harrington rod Subluminar wires Kirshneir’s wire Kirshneir’s wire holder Compression plates and

Scoliosis Spine surgeries Used in BST Used in BST Inter-trochanteric of the

Femoral-tibial component

James M. Alo, RN, MAN, MAPsycho, Ph.D

Total knee replacement arthroplasty Tension bond wiring Application of the antibiotic beads Luque rod instrumentation

Compression hip screw Page

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screws AO Screw driver Wire cutter Gigli saw Staple wire remover Skin stapler (after 7 days it will be removed) Osteotomes and mallet Intramedullary nail

Intramedullary locking screws Bone drill Drillbit Buttress plate/T plate Intramedullary nail extractor EXTERNAL FIXATORS Roger’s anderson Hybrid external fixator Ilizarov Modified skin external fixator Spanning external fixator Hoffman’s external fixator

femur

fixation

Amputation of long bones

Fracture of the middle third of Open reduction the femur intramedullary nailing for fracture of middle third of femur Fracture of distal of Open reduction femur/tibia intramedullary nailing with static locking screws For preparation for screw fixation Fracture of the proximal tibia Inserted laterally to the hip Comminuted fracture Periarticular injury of the ankle and knee-t Long bones with malunion (promotes bone growth and lengthening) Long bones (distal femur/proximal tibia) Fracture of pelvis (superior and inferior)

Application of roger’s anderson external fixators Application of hybrid external fixators Application of ilizarov external fixator

Application of spanning external fixator Applicayion of hoffman’s external fixator

Fractures · Simple (closed) · Compound (open) 5 Cardinal Signs of Fracture: · Swelling · Tenderness James M. Alo, RN, MAN, MAPsycho, Ph.D

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· · ·

Pain Crepitus Loss of function

Treating Fractures: · Reduction (Open or closed reduction) · Realignment · Rehabilitation

Stages of Bone Healing: · Hematoma formation · Cellular proliferation · Callus formation · Ossification · Consolidation and remodeling GADGETS Traction · Manual Traction · Skeletal Traction · Skin Traction (adhesive skin traction and non-adhesive skin traction) I. 1. 2. 3. 4. 5. II.

SKELETAL TYPE OF TRACTION Halo femoral traction – severe scoliosis Halo pelvic traction – scoliosis 90-90 degrees – sub-trochanteric of the femur Overhead traction – supracondylar of the humerus Balanced skeletal traction (BST) – hip and femur affection SKIN ADHESIVE TRACTION

1. Dunlop traction – supracondylar fracture of the humerus James M. Alo, RN, MAN, MAPsycho, Ph.D

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2. Bryant’s traction – hip and femur affection for children ages 6 years old or 3 years old and below; congenital hip dislocation 3. Buck’s extension – hip and femur affection for adults 4. Zero degree – for the neck of the humerus III. 1. 2. 3. 4. 5.

SKIN NON-ADHESIVE TRACTION Cotrel – combination of head halter and pelvic girdle traction; for scoliosis Pelvic girdle traction – for lumbo-sacral affection; for HNP (herniated nucleus pulposus) Hammock’s suspension – pelvic affections Head halter traction – for cervical spine affection Boot cast traction – special type of traction for hip and knee contractures and post-polio with residual paralysis

Casts (it can be either plaster of paris or made up of fiber glass) (purposes): · Immobilization · · Prevent and correct fractures · Maintain good alignment · Elevation · Model in making and artificial limb Principles for application: · Immobilized the t below and t above · Always apply a padding material · Apply the cast in circular motion using the palm Equipments in removal: · Cast cutter · Cast spreader · Cast knife · Bandage scissors I.

UPPER EXTREMITIES

James M. Alo, RN, MAN, MAPsycho, Ph.D

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1. 2. 3. 4. 5. 6. 7. 8.

Body cast – lower thoracic and upper lumbar Minerva – upper dorsal; cervical spine Rizzer’s jacket – scoliosis Collar cast – cervical cast affection Hanging cast – fracture of the shaft of the humerus Functional cast – fracture of the shaft of the humerus with callus formation Long arm circular cast – fracture of the radius and ulna Long arm posterior mold – fracture of the radius and ulna with wound swellung and infection 9. Short arm posterior mold – fracture of the wrist and finger with open wound swelling and infection 10. Munster/fuenster cast – fracture of the radius and ulna with callus formation 11. Shoulder spica cast – fracture of the upper portion of the humerus and the shoulder t 12. Sugar tong – fracture of the upper portion of the humerus and shoulder t with open wound swelling and infection 13. Airplane cast – fracture of the neck of the humerus/recurrent shoulder dislocation 14. Thumb spica cast – fracture of the first metacarpal bone

II.

LOWER EXTREMITIES

1. Pantalon cast – pelvic affections 2. Brace cast – fracture of the distal third of femur with callus formation 3. Quadrilateral cast – fracture of the shaft of the femur with callus formation 4. Double hip spica cast – hip and femur affections 5. 1 ½ hip spica cast – hip and femur affections 6. Single hip spica cast – hip and femur affections 7. Basket cast – severe/massive bone injury 8. Frog cast – for congenital hip dislocations 9. Delvit cast – fracture of the distal third of the tibia-fibula with callus formation 10. Cylinder cast – for patellar affections 11. Cylinder mould – fracture of the patella with open wound swelling and infection 12. Single hip spica mould – fracture of the hip and femur with open wound swelling and infection 13. Long leg circulr cast – tibia and fibula affections 14. Short leg circular cast – ankles, tarsals and metatarsals affections James M. Alo, RN, MAN, MAPsycho, Ph.D

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15. Patellar tendon bearing cast (PTB) – tibia-fibula with callus formation 16. Long leg posterior mould – tibia-fibula affections with open wound swelling and infection 17. Short leg posterior mould – ankles, tarsals and metatarsals affections with open wound swelling and infection 18. Internal rotator board/splint – hip surgery (partial and total hip surgery) Braces – mechanical for weakened muscles, bones and ts (purposes): · Immobilization · · Prevent and correct fracture · Maintain good body alignment · Control involuntary movements · Permits patient to walk without fatigue 1. Shuntz collar-cervical spine affections 2. Philadelphia collar – cervical spine affections 3. Forester – cervico thoraco lumbar spine affections 4. Taylor brace – upper thoracic affections; pott’s disease 5. Jewett’s brace – lower thoracic and upper lumbar affections 6. Chairback – lumbo sacral affections; HNP (herniated nucleus pulposus) 7. Yamamoto – scoliosis 8. Milwaukee – scoliosis 9. Unilateral long leg brace – post-polio with residual paralysis 10. Bilateral long leg brace – post-polio with residual paralysis 11. Openheimer – residual nerve paralysis 12. Banjo splint – peripheral nerve paralysis 13. Dennis browne shoes – clubfoot 14. SOMI (sterno-occipito-mandibular-immobilizer) – spinal injuries

James M. Alo, RN, MAN, MAPsycho, Ph.D

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