MS Care Modalities Connie K. Cupples, MS, MSN, RN

Care Modalities Casts – nonplaster & plaster Traction – Skin & skeletal External fixation devices – pins Open reduction with internal fixation Artificial joint replacement – hip, knee Casts – nonplaster & plaster Traction – Skin & skeletal External fixation devices – pins Open reduction with internal fixation Artificial joint replacement – hip, knee

Nursing Interventions for Patient in a Cast Pain relief – elevate the part, cold application & analgesics as ordered (unrelieved pain may indicate compartment syndrome) Improve mobility – ROM to all immobilized joints Promote healing of skin abrasions – clean and apply sterile dressing to areas, observe for s/s of infection Pain relief – elevate the part, cold application & analgesics as ordered (unrelieved pain may indicate compartment syndrome) Improve mobility – ROM to all immobilized joints Promote healing of skin abrasions – clean and apply sterile dressing to areas, observe for s/s of infection

Nursing interventions cont’d Maintain neurovascular function – early recognition and reporting to MD of s/s of unrelieved pain, pain on passive stretch, paresthesia, motor loss, sensory loss, coolness, pallor, slow capillary refill, sensation of tightness (may indicate compartment syndrome) Elevate extremity no higher than heart level and call MD STAT Maintain neurovascular function – early recognition and reporting to MD of s/s of unrelieved pain, pain on passive stretch, paresthesia, motor loss, sensory loss, coolness, pallor, slow capillary refill, sensation of tightness (may indicate compartment syndrome) Elevate extremity no higher than heart level and call MD STAT

Potential Complications for Patient in a Cast Compartment Syndrome – circulation and function are compromised Pressure Ulcers – observe for s/s Disuse Syndrome – muscle atrophy occurs Compartment Syndrome – circulation and function are compromised Pressure Ulcers – observe for s/s Disuse Syndrome – muscle atrophy occurs

Teaching the Patient with a Cast Home Care Mobility aids & safety Prescribed exercise Elevate extremity to heart level Keep cast dry & cushion rough edges Don’t scratch under cast Report indicators of complications Avoid excessive use of injured extremity Report broken cast Mobility aids & safety Prescribed exercise Elevate extremity to heart level Keep cast dry & cushion rough edges Don’t scratch under cast Report indicators of complications Avoid excessive use of injured extremity Report broken cast

Management of Patient in Arm Cast Elevate immobilized arm Sling used during ambulation Neurovascular checks – observe for Volkmann’s contracture Elevate immobilized arm Sling used during ambulation Neurovascular checks – observe for Volkmann’s contracture

Management of Patient in a Leg Cast Elevate to heart level Apply ice for 1-2 days as prescribed Encourage recumbent position several times a day Assess circulation and nerve function (peroneal injury may cause footdrop) Teach use of assistive devices (transfer & ambulating) Use of cast boot or reinforcement of cast if weight-bearing is allowed Elevate to heart level Apply ice for 1-2 days as prescribed Encourage recumbent position several times a day Assess circulation and nerve function (peroneal injury may cause footdrop) Teach use of assistive devices (transfer & ambulating) Use of cast boot or reinforcement of cast if weight-bearing is allowed

Nursing Interventions with a Patient in a Body or Spica Cast Turn q 2h to unaffected side (3-4 persons) Prone position bid if not contraindicated Skin care Fracture bedpan with plastic pads Observe for cast syndrome – psychological & physiological Turn q 2h to unaffected side (3-4 persons) Prone position bid if not contraindicated Skin care Fracture bedpan with plastic pads Observe for cast syndrome – psychological & physiological

Types of Hip Spica Casts

Managing Pt with Splints & Braces Teach pt how to apply device Neurovascular checks Assess comfort when using device Encourage to wear as prescribed Refer pt for adjustments as needed Teach pt how to apply device Neurovascular checks Assess comfort when using device Encourage to wear as prescribed Refer pt for adjustments as needed

Nursing Interventions for Pt With an External Fixator Pt teaching prior to application Elevate extremity Monitor neurovascular status q 2-4 h Assess pin site for s/s of infection Pin care as prescribed Encourage isometric and active exercises Physical therapy referral may be ordered Pt teaching prior to application Elevate extremity Monitor neurovascular status q 2-4 h Assess pin site for s/s of infection Pin care as prescribed Encourage isometric and active exercises Physical therapy referral may be ordered

Nursing Interventions with Skin Traction Keep leg in proper alignment Keep traction bandage free of wrinkles Maintain countertraction Do not turn but assist to shift position Measures to prevent skin breakdown Assess for nerve pressure Circulation checks q 1-2 h Encourage active foot exercises Keep leg in proper alignment Keep traction bandage free of wrinkles Maintain countertraction Do not turn but assist to shift position Measures to prevent skin breakdown Assess for nerve pressure Circulation checks q 1-2 h Encourage active foot exercises

Nursing Interventions with a Pt in Skeletal Traction Ensure that weights hang freely & that ropes, knots, and pulleys are correct Maintain proper body alignment & foot in neutral position Prevent skin breakdown Bed changed from top to bottom Neurovascular checks q 4h Pin site care tid or as prescribed Encourage exercise within therapeutic limits Ensure that weights hang freely & that ropes, knots, and pulleys are correct Maintain proper body alignment & foot in neutral position Prevent skin breakdown Bed changed from top to bottom Neurovascular checks q 4h Pin site care tid or as prescribed Encourage exercise within therapeutic limits

QUESTIONS What are three potential complications that a patient in skeletal traction may develop? Identify nursing interventions to prevent the above complications. What are three potential complications that a patient in skeletal traction may develop? Identify nursing interventions to prevent the above complications.

Nursing Interventions for Pt. with Total Hip Replacement Keep leg in abduction to prevent dislocation of the prosthesis – use abduction pillow to keep hips abducted When turning, keep hip abducted Turn from side to side unless surgeon orders not to turn to affected side Teach pt to avoid flexion of affected hip Don’t elevate HOB more than 60 degrees Observe for s/s of dislocation Keep leg in abduction to prevent dislocation of the prosthesis – use abduction pillow to keep hips abducted When turning, keep hip abducted Turn from side to side unless surgeon orders not to turn to affected side Teach pt to avoid flexion of affected hip Don’t elevate HOB more than 60 degrees Observe for s/s of dislocation

Teaching Pt to Avoid Hip Dislocation Don’t cross legs Keep knees apart Sleep with pillow between legs Don’t bend forward when seated Don’t bend to pick up objects on floor Use high-seated chair & raised toilet seat Don’t flex hip while dressing Use a “reaching device” to assist with activities Don’t cross legs Keep knees apart Sleep with pillow between legs Don’t bend forward when seated Don’t bend to pick up objects on floor Use high-seated chair & raised toilet seat Don’t flex hip while dressing Use a “reaching device” to assist with activities

Nursing Interventions cont’d Observe wound drainage (expect ml in 1 st 24 h, 30ml or less in 48h) Measures to prevent DVT (fluids, exercise, TEDs, SCDs, ambulate, heparin or Lovenox as ordered) Prevent infection (antibiotics as ordered) Teach self care to prepare for discharge Continuity of physical therapy, use of assistive devices Observe wound drainage (expect ml in 1 st 24 h, 30ml or less in 48h) Measures to prevent DVT (fluids, exercise, TEDs, SCDs, ambulate, heparin or Lovenox as ordered) Prevent infection (antibiotics as ordered) Teach self care to prepare for discharge Continuity of physical therapy, use of assistive devices

Post-op Nursing Interventions for Pt with Total Knee Replacement Observe dressing for bleeding/drainage Ice as ordered Neurovascular checks Pain meds as ordered Active flexion of foot q1h while awake Observe CAC in wound suction drainage Continuous passive motion (CPM) device Early ambulation with knee immobilizer Physical therapy as ordered Observe dressing for bleeding/drainage Ice as ordered Neurovascular checks Pain meds as ordered Active flexion of foot q1h while awake Observe CAC in wound suction drainage Continuous passive motion (CPM) device Early ambulation with knee immobilizer Physical therapy as ordered

QUESTIONS In the post-op care of the patient undergoing orthopedic surgery, name 5 potential complications for which the nurse would monitor. Give nursing assessments and interventions to prevent these complications. In the post-op care of the patient undergoing orthopedic surgery, name 5 potential complications for which the nurse would monitor. Give nursing assessments and interventions to prevent these complications.

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