Objectives § Describe assessment of an orthopaedic patient § Demonstrate use of orthopaedic splints and braces § Identify skin care issues in the orthopaedic patient § State signs and symptoms of orthopaedic complications Assessment § ABC’s - Monitor VS; circulation, motor, sensory checks (CMS checks) specifically to affected extremity § Level of Consciousness § Lung Sounds, respirations, oxygen saturations, need for supplemental oxygen Assessment Cont. § Bowel sounds, last BM, urinary complications § Incision area : drainage, ecchymosis, edema § Appetite, Nausea, Vomiting § Activity Tolerance (muscle strength, movement, atrophy, contracture) § Sleep Assessment Cont. § Pain - where is the pain? - when did the pain begin? - what makes it worse? - what relieves the pain? (positioning, ice, analgesics, mobility) - describe the pain and rate intensity Pain control is a key factor in improving a patient’s recovery. Adequate pain control promotes earlier mobilization and improves circulation. Fractures § CMS checks: - pulses distal to injury (palpable or need doppler) - capillary refill - color - motor function distal to fracture - sensory function distal to fracture Fractures Cont. § Open fracture- high concern for infection (osteomylitis, sepsis) § Closed fracture § Close monitoring of patients with unstable pelvis fractures - increased risk for hypovolemic shock External Fixator • proper pin site care • monitor for signs of infection. Uses of Splints and Braces § Acute injuries § Chronic conditions § Preven Examples of Splints and Braces § wrist splint for carpal tunnel syndrome § Semi-rigid ankle brace for ankle sprain § Knee brace after ACL surgery or total knee replacement § Quadriceps rupture, patellar fracture or dislocation § MCL rupture § After ACL surgery Splints and Braces Cont. § Keep swelling down it can create pressure under splint, brace or cast - elevate affected extremity - exercise joints above and below the splint, brace or cast - ice the affected area - splint should be well padded Splints and Braces Cont. Splints and Braces Cont. Knee Immobilizer Correct way to wear Wrong way to wear Splints and Braces Cont. T-ROM Brace Splints and Braces Cont. Abduction pillow shoulder sling Correct way to wear Correct way to wear Splints and Braces Cont. Abduction pillow shoulder sling Wrong way to wear Wrong way to wear Splints and Braces Cont. Arm sling Correct way to wear Wrong way to wear Cold Compression § Routinely used immediately after acute injury or following surgery § Cold can help reduce pain by reducing inflammation and swelling Skin Care Issues Pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Skin Care Issues Cont. § Obesity and low body weight individuals tend to be at greater risk for developing pressure ulcers § Orthopaedic patients tend to be more immobile initially post-op, particularly the elderly, which increases the risk of friction and shearing Skin Care Issues Cont. § Use of Braden Scale to identify the risk of skin and pressure issues for your patient. § Use interventions to help decrease your patient’s risk (proper transfers, frequent repositioning, use of air mattress, mobilize, protective dressings) Tissue tolerance for pressure Influenced by intrinsic factors: § Nutritional status § Age § Low arteriolar pressure Influenced by extrinsic factors: § Skin moisture § Friction § Shear Skin Care Issues Cont. Stage 1 Pressure Ulcer Stage 2 Pressure Ulcer Pressure Ulcer § Off load heals § Keep skin dry § Reposition § Get out of bed § Monitor bony prominences § Straight linens § Monitor where tubing lays (oxygen tubing on ears) Orthopaedic Complications Surgical Site Infection § Redness § Delayed healing § Fever § Pain §