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Patient usually place on prophylactic anticoagulation with heparin or Lovenox then moved to coumadin or aspirin

Osteomyelitis -- infection within the bone; s/s ? redness, edema, pain, pus, fever; treatment C&S, IV antibiotics, surgical drainage and debridement; prevent by strict asepsis with all open wounds communicating with bone; condition is usually acute, but may become chronic; difficult to treat and cure; long term, high dose ABT

Non-union due to insufficient callus formation; treatment is bone grafting

Nursing Interventions for patient with a Fracture --

Pain ? administer pain meds; often a combination of an oral narcotic analgesic with an oral non-narcotic analgesic is most effective in relieving pain of fracture ? examples: Percocet (oxycodone + acetaminophen), Tylenol with codeine; Apply ice to affected area with MD order; reposition within limitations

High risk for altered tissue perfusion ? NV checks as described previously; report abnormal findings immediately

Impaired mobility ?

Positioning ? avoid altering the alignment of the fracture; avoid changing the pull of the traction; take care not to damage the cast; avoid stress on internal fixation devices; generally ? do not move patients with unreduced, non-immobilized fractures; patients with reduced and immobilized fractures can turn; patients in traction are somewhat limited by can turn slightly side-to-side; change position q 2 hours; overhead frame with trapeze enable patient to help adjust position

Preserve strength and mobility ? encourage movement to the greatest possible extent; encourage self-care to extent possible; isometric exercises (gluteal, quadriceps); isotonic exercises (bed push-ups, pull-ups on trapeze); ROM to unaffected extremities

Maintain skin integrity ? visually inspect pressure points at least q 8 hours; turn or change position q 2 hours; protective devices ? low pressure bed, elbow and heel protectors; check all appliances for skin irritation (traction, casts)

Prevent respiratory, circulatory complications ? cough and deep breathing; exercise as described; change position q 2; mobilize or ambulate patient as soon as possible

Constipation (due to immobility, inadequate fluid intake, narcotic analgesics) ? increase fluids to 3000 cc/day; increase dietary bulk; provide privacy, comfort, regularity; stool softeners, suppositories, Fleets, laxatives prn

Risk for altered urinary function ? patients who are immobilized get an increased serum calcium level because of bone loss; they may develop bladder stones from this; may also have stasis of urine due to incomplete emptying of bladder if voiding in a lying down position

For optimum bladder function ? increase fluids 2000-3000 cc/day; optimal positioning for voiding; check frequently for retention; monitor I&O

Nutritional deficit ? for optimum healing of fractures, need increased protein, vitamins, minerals in diet; provide a well balanced diet to meet patient's needs; monitor food intake; provide protein supplements if needed

Patient in a Cast

Materials ? plaster of paris, fiberglass, plastic

Plaster ? wet before application, is heavy; need to keep dry because will soften and crumble if gotten wet; inexpensive; may be changed several times

Fiberglass and plastic ? dry quickly, light weight; can be wet and still maintain their rigidity; if gotten wet, can dry with a hairdryer

Casts completely encircle the extremity or trunk; splint is the same materials but does not completely encircle the body part; like a half-cast; held in place with a bandage, often an Ace bandage

Casts are applied over clean skin; skin may be covered with cotton sheeting or stockinette; body prominences padded with cotton wadding or felt

Cast removal ? electric cast saw; will not cut skin

Cast care ?

Teach patient ? plaster feels warm as it dries; keep the cast dry; put no sharp objects into the cast (for scratching)

Support wet plaster with the palms of the hand only; fingertips will make indentations in the cast that can produce pressure areas on underlying skin; place the wet cast on absorbent material (cotton blanket); do not cover the wet cast ? allow to air dry

Circulatory ? NV checks q 1 hour; ice pack to fracture site (MD order); elevate casted extremity on 1-2 pillows for 24-48 hours; any impairment of circulation ? notify MD; cast will be bivalved

If the patient has had an open reduction, the cast may have a window over the site; if not ? there may be drainage evident on the cast ? monitor the size of the drainage spot on the cast ? looking for large or increasing amounts of bright red drainage

Turn patient q 2 hours; usually any position is ok, as long as the patient is comfortable

Skin care ? watch skin at the edges of the cast for irritation and pressure; apply strips of adhesive tape or moleskin over rough edges; apply plastic around perineal area to prevent soiling of cast

Monitor cast for signs of pressure areas under cast ? patient may complain of a burning spot or a hot spot; make sure to notify MD and to document carefully; smell cast ? an area of breakdown under the cast may cause an odor; watch for areas of drainage on the cast...

Patient usually place on prophylactic anticoagulation with heparin or Lovenox then moved to coumadin or aspirin

Osteomyelitis -- infection within the bone; s/s ? redness, edema, pain, pus, fever; treatment C&S, IV antibiotics, surgical drainage and debridement; prevent by strict asepsis with all open wounds communicating with bone; condition is usually acute, but may become chronic; difficult to treat and cure; long term, high dose ABT

Non-union due to insufficient callus formation; treatment is bone grafting

Nursing Interventions for patient with a Fracture --

Pain ? administer pain meds; often a combination of an oral narcotic analgesic with an oral non-narcotic analgesic is most effective in relieving pain of fracture ? examples: Percocet (oxycodone + acetaminophen), Tylenol with codeine; Apply ice to affected area with MD order; reposition within limitations

High risk for altered tissue perfusion ? NV checks as described previously; report abnormal findings immediately

Impaired mobility ?

Positioning ? avoid altering the alignment of the fracture; avoid changing the pull of the traction; take care not to damage the cast; avoid stress on internal fixation devices; generally ? do not move patients with unreduced, non-immobilized fractures; patients with reduced and immobilized fractures can turn; patients in traction are somewhat limited by can turn slightly side-to-side; change position q 2 hours; overhead frame with trapeze enable patient to help adjust position

Preserve strength and mobility ? encourage movement to the greatest possible extent; encourage self-care to extent possible; isometric exercises (gluteal, quadriceps); isotonic exercises (bed push-ups, pull-ups on trapeze); ROM to unaffected extremities

Maintain skin integrity ? visually inspect pressure points at least q 8 hours; turn or change position q 2 hours; protective devices ? low pressure bed, elbow and heel protectors; check all appliances for skin irritation (traction, casts)

Prevent respiratory, circulatory complications ? cough and deep breathing; exercise as described; change position q 2; mobilize or ambulate patient as soon as possible

Constipation (due to immobility, inadequate fluid intake, narcotic analgesics) ? increase fluids to 3000 cc/day; increase dietary bulk; provide privacy, comfort, regularity; stool softeners, suppositories, Fleets, laxatives prn

Risk for altered urinary function ? patients who are immobilized get an increased serum calcium level because of bone loss; they may develop bladder stones from this; may also have stasis of urine due to incomplete emptying of bladder if voiding in a lying down position

For optimum bladder function ? increase fluids 2000-3000 cc/day; optimal positioning for voiding; check frequently for retention; monitor I&O

Nutritional deficit ? for optimum healing of fractures, need increased protein, vitamins, minerals in diet; provide a well balanced diet to meet patient's needs; monitor food intake; provide protein supplements if needed

Patient in a Cast

Materials ? plaster of paris, fiberglass, plastic

Plaster ? wet before application, is heavy; need to keep dry because will soften and crumble if gotten wet; inexpensive; may be changed several times

Fiberglass and plastic ? dry quickly, light weight; can be wet and still maintain their rigidity; if gotten wet, can dry with a hairdryer

Casts completely encircle the extremity or trunk; splint is the same materials but does not completely encircle the body part; like a half-cast; held in place with a bandage, often an Ace bandage

Casts are applied over clean skin; skin may be covered with cotton sheeting or stockinette; body prominences padded with cotton wadding or felt

Cast removal ? electric cast saw; will not cut skin

Cast care ?

Teach patient ? plaster feels warm as it dries; keep the cast dry; put no sharp objects into the cast (for scratching)

Support wet plaster with the palms of the hand only; fingertips will make indentations in the cast that can produce pressure areas on underlying skin; place the wet cast on absorbent material (cotton blanket); do not cover the wet cast ? allow to air dry

Circulatory ? NV checks q 1 hour; ice pack to fracture site (MD order); elevate casted extremity on 1-2 pillows for 24-48 hours; any impairment of circulation ? notify MD; cast will be bivalved

If the patient has had an open reduction, the cast may have a window over the site; if not ? there may be drainage evident on the cast ? monitor the size of the drainage spot on the cast ? looking for large or increasing amounts of bright red drainage

Turn patient q 2 hours; usually any position is ok, as long as the patient is comfortable

Skin care ? watch skin at the edges of the cast for irritation and pressure; apply strips of adhesive tape or moleskin over rough edges; apply plastic around perineal area to prevent soiling of cast

Monitor cast for signs of pressure areas under cast ? patient may complain of a burning spot or a hot spot; make sure to notify MD and to document carefully; smell cast ? an area of breakdown under the cast may cause an odor; watch for areas of drainage on the cast...

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