ORTHOPEDIC SURGERY
Types of Surgery
Open reduction → reduction and alignment of the fracture through surgical incision.
Closed reduction → manipulation of bone fragments or joint dislocation without incision
Internal fixation → stabilization of reduced fracture using metal screw, plates, nails, pins
Bone graft → use of bone tissue to replace, promote healing or stabilize diseased bone.
Arthroplasty → repair of a joint; may be done through (arthroscopy) or open joint.
Joint replacement → replacement of joint surfaces with metal or plastic materials.
Total joint replacement → replacement of both articular surfaces within a joint.
Meniscectomy → excision of damaged meniscus (fibrocartilage) of the knee.
Tendon transfer → movement of tendon insertion point to improve function.
Fasciotomy → cutting muscle fascia to relieve constriction or contracture.
Amputation → removal of a body part.
Preoperative Management and Nursing Care
☺ Assess patient for adequate hydration, protein, and caloric intake.
☺ Assess patient for previous corticosteroid therapy → could contribute to current
orthopedic condition, affect the patient's response to anesthesia and the stress of surgery.
☺ Evaluate for infection (cold, dental, skin, UTI), which could contribute to development of
osteomyelitis after surgery (determine if preoperative antibiotics is necessary).
☺ Coughing & deep breathing, frequent vital sign and wound checks, repositioning are
described to prepare patient.
☺ Patient should practice voiding in bedpan in recumbent position before surgery.
☺ The patient is acquainted with traction apparatus and the need for splint or cast.
☺ Review discharge and rehabilitation options post-surgery.
Postoperative Management and Nursing Care
Monitor neurovascular status, & control swelling caused by edema & tissues bleeding.
Immobilize & limit activity to operative site to stabilize musculoskeletal structures.
Monitor for hemorrhage and shock, result from significant bleeding and poor hemostasis.
Prevent immobility complications through aggressive and vigilant postoperative care.
Complications
1. Shock 2. Fat embolus 3. Thromboembolism 4. Anemia
5. Atelectasis & pneumonia 6. Compartment syndrome 7. Osteomyelitis, wound infections
1
, Nursing Diagnoses
Risk for Deficient Fluid Volume related to hemorrhage
Ineffective Breathing Pattern related to effects of anesthesia, analgesics, and immobility
Risk for Peripheral Neurovascular Dysfunction related to swelling
Acute Pain related to surgical intervention
Risk for Infection related to surgical intervention
Impaired Physical Mobility related to immobilization therapy and pain
Imbalanced Nutrition: Less Than Body Requirements related to blood loss and the
demands of healing
Nursing Interventions
1) Monitoring for Shock and Hemorrhage
Evaluate BP & PR frequently → rising pulse rate, widening pulse pressure, or slowly
falling BP indicate → persistent bleeding or development of a state of shock.
Monitor for hemorrhage → orthopedic wounds have a tendency to ooze.
oMeasure suction drainage if used.
o Anticipate up to 500 mL in the 1st 24 hours, < 30 mL per 8 hours within 48 hours.
o Report increased wound drainage or steady increase in pain of operative area.
Administer I.V. fluids and blood products as ordered.
2) Promoting Effective Breathing Pattern
Give respiratory depressant drugs cautiously. Monitor respiration depth & rate
frequently. Opioid analgesic effects may be cumulative.
Change position/2 hours → mobilizes secretions & helps prevent bronchial obstruction.
Encourage use of incentive spirometer & coughing and deep-breathing exercises/2 hours.
Auscultate lungs for atelectasis and retention of secretions.
3) Monitoring Peripheral Neurovascular Status
Watch distal circulation to the part where cast, bandage, or splint has been applied.
Prevent constriction leading to interference with blood or nerve supply.
Elevate affected extremity & apply ice packs to reduce swelling & bleeding into tissues.
Observe toes and fingers for healthy color and good capillary refill.
Check pulses of affected extremity; compare with unaffected extremity.
Note skin temperature and sensation.
Document observations.
2
Types of Surgery
Open reduction → reduction and alignment of the fracture through surgical incision.
Closed reduction → manipulation of bone fragments or joint dislocation without incision
Internal fixation → stabilization of reduced fracture using metal screw, plates, nails, pins
Bone graft → use of bone tissue to replace, promote healing or stabilize diseased bone.
Arthroplasty → repair of a joint; may be done through (arthroscopy) or open joint.
Joint replacement → replacement of joint surfaces with metal or plastic materials.
Total joint replacement → replacement of both articular surfaces within a joint.
Meniscectomy → excision of damaged meniscus (fibrocartilage) of the knee.
Tendon transfer → movement of tendon insertion point to improve function.
Fasciotomy → cutting muscle fascia to relieve constriction or contracture.
Amputation → removal of a body part.
Preoperative Management and Nursing Care
☺ Assess patient for adequate hydration, protein, and caloric intake.
☺ Assess patient for previous corticosteroid therapy → could contribute to current
orthopedic condition, affect the patient's response to anesthesia and the stress of surgery.
☺ Evaluate for infection (cold, dental, skin, UTI), which could contribute to development of
osteomyelitis after surgery (determine if preoperative antibiotics is necessary).
☺ Coughing & deep breathing, frequent vital sign and wound checks, repositioning are
described to prepare patient.
☺ Patient should practice voiding in bedpan in recumbent position before surgery.
☺ The patient is acquainted with traction apparatus and the need for splint or cast.
☺ Review discharge and rehabilitation options post-surgery.
Postoperative Management and Nursing Care
Monitor neurovascular status, & control swelling caused by edema & tissues bleeding.
Immobilize & limit activity to operative site to stabilize musculoskeletal structures.
Monitor for hemorrhage and shock, result from significant bleeding and poor hemostasis.
Prevent immobility complications through aggressive and vigilant postoperative care.
Complications
1. Shock 2. Fat embolus 3. Thromboembolism 4. Anemia
5. Atelectasis & pneumonia 6. Compartment syndrome 7. Osteomyelitis, wound infections
1
, Nursing Diagnoses
Risk for Deficient Fluid Volume related to hemorrhage
Ineffective Breathing Pattern related to effects of anesthesia, analgesics, and immobility
Risk for Peripheral Neurovascular Dysfunction related to swelling
Acute Pain related to surgical intervention
Risk for Infection related to surgical intervention
Impaired Physical Mobility related to immobilization therapy and pain
Imbalanced Nutrition: Less Than Body Requirements related to blood loss and the
demands of healing
Nursing Interventions
1) Monitoring for Shock and Hemorrhage
Evaluate BP & PR frequently → rising pulse rate, widening pulse pressure, or slowly
falling BP indicate → persistent bleeding or development of a state of shock.
Monitor for hemorrhage → orthopedic wounds have a tendency to ooze.
oMeasure suction drainage if used.
o Anticipate up to 500 mL in the 1st 24 hours, < 30 mL per 8 hours within 48 hours.
o Report increased wound drainage or steady increase in pain of operative area.
Administer I.V. fluids and blood products as ordered.
2) Promoting Effective Breathing Pattern
Give respiratory depressant drugs cautiously. Monitor respiration depth & rate
frequently. Opioid analgesic effects may be cumulative.
Change position/2 hours → mobilizes secretions & helps prevent bronchial obstruction.
Encourage use of incentive spirometer & coughing and deep-breathing exercises/2 hours.
Auscultate lungs for atelectasis and retention of secretions.
3) Monitoring Peripheral Neurovascular Status
Watch distal circulation to the part where cast, bandage, or splint has been applied.
Prevent constriction leading to interference with blood or nerve supply.
Elevate affected extremity & apply ice packs to reduce swelling & bleeding into tissues.
Observe toes and fingers for healthy color and good capillary refill.
Check pulses of affected extremity; compare with unaffected extremity.
Note skin temperature and sensation.
Document observations.
2
