asymmetry

ROM

pain

what is a pt with a compound / open fracture

(through the skin) at risk for

at risk for infection

needs IV antibiotics

nursing considerations for fracture

name 4

1. if you suspect a fracture immobilize the affected part do not attempt to reduce
2. monitor CMST
3. monitor 7 p's
4. after casting or surgery elevate limb to reduce pain and edema 

1. Pain
2. Pallor
3. paresthesia
4. paralysis
5. polar temperature
6. puffiness
7. pulselessness 

1. support cast with pillows to preserve original shape
2. keep cast uncovered
3. handle wet cast with palms only (finger pressure can dent a cast and create pressure points)
4. Cover rought edges with tape (petaling
5. monitor CMST and 7 P's
6. Instruct client not to put anything inside of cast
7. monitor for infection - odor and hot spot 

a device used to manage complex fractures that are associated either with soft tissue damage or open wounds in the fracture area - holds pins in place and maintains immobilization

1. monitor CMST and infection
2. provide care of pin sites
3. Sterile dressing changes
4. gently pull skin away from pin sites
5. monitor for rejection of metal alloy

Color / Circulation

• Pale - impaired circulation
• Prolonged capillary refill - impaired circulation

Movement

• Should be able to wiggle the toes

Sensation

• Should not have numbness and tingling

Temperature

• Cold - impaired circulation, hot - infection

what do we need to monitor for with a fracture of the pelvis?

Hematuria

Risk for hemorrhage, very vascular

Spica cast - nursing considerations

name 2

1. pay special attention to elimination and the area near the buttocks for skin breakdown
2. monitor for constipation 

• ↓ b/p
• ↑ pulse
• pallor / pale
• ↓ neuro status, ↓ LOC
• cool, clammy
• diaphoretic
• restless

a type of skin traction - knee is suspended in a sling creating upward pull from the knee with lower leg in horizontal traction in hip and knee fractures

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monitor popliteal area for:

• pressure
• swelling
• damage to nerves and blood vessels

a type of skin traction -provides a straight pull on extended extremity in hip fractures

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for small children with unstable hjip or femur fractures - legs suspended in air at a 90° angle from hips, knees slightly flexed, buttocks off bed

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• assess, document and report neurovascular impairment
• ensure correct weight of weights used
• observed skin: elbow in Dunlop's and popliteal in Russell's traction
• assess distal pulses for circulatory integrity
• inspect for loss of sensation  
• assess pin sites in skeletal traction and cleanse as ordered

RA - rheumatoid arthritis

SLE - systemic Lupus Erythematosus

what kind of machine is used to increase extension and flexion of the joint after knee surgery

• ↑ leg for 24 hours to enhance venous return
• turn every 2 hours
• monitor for infection
• CPM machine - passive flexion
• pain management
• progressive leg exercises to obtain 90° flexion and quadriceps for leg lifts
• leg immobilizer when out of bed 

• Obese
• Infection

Hip surgery nursing considerations:

name 10

1. keep affected leg abducted at all times to keep hip in socket (abductor pillow)
2. use trochanter roll to prevent external rotation of limb
3. monitor for bleeding under the client 
4. prevent hip flexion by elevating HOB 20-30 degrees only for meals
5. turn on non-operative side

• teach quadriceps exercise
• use a raised toilet seat - prevent hip flexion
• no bending, no crossing legs
• do no sit in low chairs
• flex and dorsiflex foot and use antiembolic hose to prevent DVT

• numbness
• tingling
• loss of sensation
• inability to move extremities
• pallor
• cool skin
• edema

Complications of Fracture or bone surgery:

osteoyelitis - serious bone infection

s/s:

tx:

s/s:

• pain
• fever
• flushed apperance
• ↑ WBC
• ↑ ESR
• positive wound cultures

tx:

• IV ANTIBIOTICS

s/s of intervertebral disk disease

also known as heriniated disk, slipped disk or sciatica

• back, shoulder, neck or leg pain
• numbness
• pain most often occuring on the side and radiation over buttock and down leg (sciatica)
• numbness and tingling that is worse when coughing, sneezing, bending, or lifting
• muscle spasam

tx for intervertebral disk disease

(sciatica, slipped disk, herniated disk)