Orthopedic Nursing Care
What is the most commonly reported injuries? - -Contusions, Strains, and Sprains.
-Contusion - -Blunt force-bleeding into soft tissue, but skin remains intact. (Swelling,
discoloration of skin) Least serious
-Strain - -Stretching injury to a muscle or a muscle-tendon unit. Caused by
mechanical overloading. (Pain, limited motion, muscle spasms/weakness, swelling.)
Most common: lower abck and Hamstring muscle
-Sprain - -Stretch/tear of ligaments surrounding joint. (Loss of the ability to move or
use the joint, feeling a "pop" or tear, discoloration, pain, rapid swelling.) Most
common: ankles and knees
-RICE - -Rest Ice Compression Elevation 24-48hrs do RICE.
-Joint dislocation - -Trauma or illness forces ends of the bones from normal position.
(Pain, deformity, limited motion, shorter limb) Care: Reduction by manual traction or
surgery immobilization, hip dislocation requires immediate reduction to prevent
complications to prevent necrosis.
-Subluxation - -partial dislocation is which the bones of the joint remain in partial
contact
-Necrosis - -Death of bone tissue
-Electrical Bone Stimulation - -Used to treat fractures that aren't healing
appropriately, increases migration of osteoblasts and osteoclasts to fracture
site.Application of an electrical current
-What to do for fracture of the skull? - -Assess patient for neurologic changes,
document LOC, depressed skull fracture can cause neurologic damage.
-Fracture Care - -Emergency Care: Immobilize the fracture, maintain tissue
perfusion, prevent infection. Medications: Analgesics, NSAIDs,
antibiotics,anticoagulants, stool softeners, antacids. Surgery: External fixation
device, ORIF
-Fracture of the Face - -Manifestations: Hematoma, pain, edema, bony deformity.
Focus on airway, assess neurologic, body image disturbance, assess pain
-Fracture of the Spine - -Cervical, lumbar, thoracic, or sacral...damage to spinal
cord. MOST SEVERE, can result in ischemia and cause permanent paralysis.
-Fracture of the Clavicle - -Usually midclavicular, can damage subclavian vessels or
lung. Seen most common with falls
, -Fracture of Humerus - -Complications: nerve and ligament damage, frozen or stiff
joints, and malunion--fractured fragments are not in good position... Fractures of the
proximal humerus are more common in older adults.
-Fracture of the Elbow - -Usually distal humerus, common complications: nerve or
artery damage, hemiartrosis, Volkmann's contracture (claw deformity of hand and
fingers). Fall or direct blow is main report.
-Fracture of the radius and/or ulna - -Complication: compartment syndrome,
delayed healing, decreased wrist and finger movement, infection. Care: alleviate
pain, immobilization, education. ***Tell MD if changes in sensation
-Wrist Fractures - -Colle's Fracture: the distal radius fractures after a fall onto an
outstretched hand. Patient presents with bony deformity, pain, numbness,
weakness, decreased ROM of fingers.
-Hand Fractures - -Usually metacarpals and phalanges (Pain, edema, decreased
ROM) Complications: compartment syndrome, nerve damage, ligament damage,
delayed union.
-Fracture of the Ribs - -Blunt chest trauma, Can damage the spleen, liver,
subclavian artery, or vein. Flail chest; Complications: pulmonary contusion,
pnuemothorax and or hemothorax, pneumonia, intra-abdominal bleeding
-Flail Chest - -results from the fracture of two or more adjacent ribs in two or more
places and the formation of a free-floating segment that moves in the opposite
direction of the rib cage.Care: coughing, deep breathing, and splinting.
-Fracture of the Pelvis - -Caused by trauma, patient presents with back or hip pain.
Complications: hemorrhage, damage to pelvic and extra-pelvic organs. Care: Tx
discomfort, maintaining immobilization, and identify potential complications.
-Fracture of the Shaft of the femur - -Edema, deformity, pain in the thigh, inability to
move hip or knee. Complications: hypovolemia, fat embolism, hip and/or knee
dislocation, muscle atrophy, ligament damage. Provide pain meds, provide
reassurance and decreasing anxiety, assist with exercises of the lower legs, feet,
and toes. Circulation and sensation in affected extremity;skeletal traction, internal
or external fixation
-Intracapsular Fractures - -involve the head or neck of the femur...MOST SERIOUS
-Extracapsular Fractures - -Involves the trochanteric region
-Fracture of the Hip - -Intracapsular or extracapsular. Risks: Lower body weakness,
problems walking/balance, taking 4 or more meds or psychoacitve meds. Nursing:
maintain skin integrity, prevent infection, alleviate pain, manifest circulation,
increase mobility
-Causes of repetitive use Injuries - -Twisting and turning wrist
What is the most commonly reported injuries? - -Contusions, Strains, and Sprains.
-Contusion - -Blunt force-bleeding into soft tissue, but skin remains intact. (Swelling,
discoloration of skin) Least serious
-Strain - -Stretching injury to a muscle or a muscle-tendon unit. Caused by
mechanical overloading. (Pain, limited motion, muscle spasms/weakness, swelling.)
Most common: lower abck and Hamstring muscle
-Sprain - -Stretch/tear of ligaments surrounding joint. (Loss of the ability to move or
use the joint, feeling a "pop" or tear, discoloration, pain, rapid swelling.) Most
common: ankles and knees
-RICE - -Rest Ice Compression Elevation 24-48hrs do RICE.
-Joint dislocation - -Trauma or illness forces ends of the bones from normal position.
(Pain, deformity, limited motion, shorter limb) Care: Reduction by manual traction or
surgery immobilization, hip dislocation requires immediate reduction to prevent
complications to prevent necrosis.
-Subluxation - -partial dislocation is which the bones of the joint remain in partial
contact
-Necrosis - -Death of bone tissue
-Electrical Bone Stimulation - -Used to treat fractures that aren't healing
appropriately, increases migration of osteoblasts and osteoclasts to fracture
site.Application of an electrical current
-What to do for fracture of the skull? - -Assess patient for neurologic changes,
document LOC, depressed skull fracture can cause neurologic damage.
-Fracture Care - -Emergency Care: Immobilize the fracture, maintain tissue
perfusion, prevent infection. Medications: Analgesics, NSAIDs,
antibiotics,anticoagulants, stool softeners, antacids. Surgery: External fixation
device, ORIF
-Fracture of the Face - -Manifestations: Hematoma, pain, edema, bony deformity.
Focus on airway, assess neurologic, body image disturbance, assess pain
-Fracture of the Spine - -Cervical, lumbar, thoracic, or sacral...damage to spinal
cord. MOST SEVERE, can result in ischemia and cause permanent paralysis.
-Fracture of the Clavicle - -Usually midclavicular, can damage subclavian vessels or
lung. Seen most common with falls
, -Fracture of Humerus - -Complications: nerve and ligament damage, frozen or stiff
joints, and malunion--fractured fragments are not in good position... Fractures of the
proximal humerus are more common in older adults.
-Fracture of the Elbow - -Usually distal humerus, common complications: nerve or
artery damage, hemiartrosis, Volkmann's contracture (claw deformity of hand and
fingers). Fall or direct blow is main report.
-Fracture of the radius and/or ulna - -Complication: compartment syndrome,
delayed healing, decreased wrist and finger movement, infection. Care: alleviate
pain, immobilization, education. ***Tell MD if changes in sensation
-Wrist Fractures - -Colle's Fracture: the distal radius fractures after a fall onto an
outstretched hand. Patient presents with bony deformity, pain, numbness,
weakness, decreased ROM of fingers.
-Hand Fractures - -Usually metacarpals and phalanges (Pain, edema, decreased
ROM) Complications: compartment syndrome, nerve damage, ligament damage,
delayed union.
-Fracture of the Ribs - -Blunt chest trauma, Can damage the spleen, liver,
subclavian artery, or vein. Flail chest; Complications: pulmonary contusion,
pnuemothorax and or hemothorax, pneumonia, intra-abdominal bleeding
-Flail Chest - -results from the fracture of two or more adjacent ribs in two or more
places and the formation of a free-floating segment that moves in the opposite
direction of the rib cage.Care: coughing, deep breathing, and splinting.
-Fracture of the Pelvis - -Caused by trauma, patient presents with back or hip pain.
Complications: hemorrhage, damage to pelvic and extra-pelvic organs. Care: Tx
discomfort, maintaining immobilization, and identify potential complications.
-Fracture of the Shaft of the femur - -Edema, deformity, pain in the thigh, inability to
move hip or knee. Complications: hypovolemia, fat embolism, hip and/or knee
dislocation, muscle atrophy, ligament damage. Provide pain meds, provide
reassurance and decreasing anxiety, assist with exercises of the lower legs, feet,
and toes. Circulation and sensation in affected extremity;skeletal traction, internal
or external fixation
-Intracapsular Fractures - -involve the head or neck of the femur...MOST SERIOUS
-Extracapsular Fractures - -Involves the trochanteric region
-Fracture of the Hip - -Intracapsular or extracapsular. Risks: Lower body weakness,
problems walking/balance, taking 4 or more meds or psychoacitve meds. Nursing:
maintain skin integrity, prevent infection, alleviate pain, manifest circulation,
increase mobility
-Causes of repetitive use Injuries - -Twisting and turning wrist
