1. Timby/Smith : Introductory Medical-Surgical Nursing, 10/e
Chapter 61: Caring for Clients Requiring Orthopedic Treatment /24 Pg 969

2. Words to Know [12] Arthroplasty Avascular Necrosis Brace
Cast Closed Reduction
External Fixation Internal Fixation
Open Reduction Prosthesis
Splint Subluxation
Traction
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3. Learning Objectives On completion of this chapter, you will be able to
Differentiate types of casts.
Discuss the nursing management for a client with a cast
State the reasons for using splints or braces.
Identify the principles for maintaining traction and describe nursing care for the client in traction.
Differentiate between closed reduction and open reduction and between internal fixation and external fixation.
Describe nursing care for the client with a fracture reduction.
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4. Learning Objectives On completion of this chapter, you will be able to
Identify the reasons for performing orthopedic surgery.
Discuss the nursing management for a client undergoing orthopedic surgery.
Describe the positioning precautions after a conventional total hip replacement.
Explain the nursing needs of the client undergoing total knee replacement.
Discuss amputation, including reasons it may be performed and appropriate nursing management of the client
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5. Casts 05/24 Pg 969 Types of Casts Cylinder Cast Body Cast
Hip Spica Cast

6. Casts Cast Composition Fiberglas; Plaster of Paris
Alignment and support of the fractured area
Cast material feels warm during application
Support drying cast on pillows [Palms]
Cast Windows [If]
Client reports discomfort
Wound requires regular dressing change
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7. Question Is the following statement true or false?
When a limb is placed in a cast, the joint is set straight to assure bone alignment. [NCLEX TYPE]
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8. Answer
False.
When a limb is placed in a cast, the cast is applied from the joint above the break to the joint below the break. The joint is slightly flexed to decrease joint stiffness. The Reduction aligns the bone ends
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9. Casts Bivalve Cast Used: With swollen arm or limb
When being weaned from a cast
When sharp radiograph is needed
As a splint
Cast Removal [Vibrating saw]
Nursing Management
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10. Splints, Braces Splints
Immobilize and support an injured body part in a functional position
Braces
Provide support
Control movement
Prevent additional injury
Provide client and family education
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11. Question Is the following statement true or false?
Braces provide support, control movement, and prevent additional injury.
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12. Answer
True.
Braces provide support, control movement, and prevent additional injury for long-term use. They are made of various materials and are custom fit to the client. Scrupulous skin care is vital to maintain skin integrity.
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13. Reducing Fractures 13/24 Pg 971
Cast
Application
External
Fixation
Internal
Open
Reduction
Closed
Traction
Treatment
of Fractures

14. Reducing Fractures 14/24 Pg 973
Figure 61-3 Examples of skin traction
Figure 61-6 External fixation

15. Orthopedic Surgery Open Reduction Internal Fixation Buck’s extension
Nails; Intramedullary rod
Internal fixation devices
Joint Dysfunction Correction
Arthroplasty; Arthrodesis
Osteotomy; Hemiarthroplasty
Total arthroplasty
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16. Orthopedic Surgery Complications 16/24 Pg 979
Loosening
of cemented
prosthesis
Avascular
Necrosis
Thrombo-
embolism
Infection
Subluxation
Hemorrhage
Postoperative
Complications

17. Orthopedic Surgery Preoperative Nursing Management
Obtain complete history
Assess complications from previous treatment
Assist in reducing pain, risk of infection, and increasing mobility
Help control anxiety and understand instructions
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18. Orthopedic Surgery Postoperative Nursing Management
Required demonstrations
Postsurgery devices
Reduce risk for excessive bleeding
Review physician orders
Flexion of CPM devices and movement
Help reduce pain and inflammation
Prevent postoperative complications
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19. Orthopedic Surgery Client and Family Teaching
Support system after discharge
Explore the kinds of assistance needed
Modifications needed in the home environment
Information about home care
Referral to a home healthcare agency
Printed discharge instructions
Activity; PT; Symptoms to report
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20. Amputation Etiology Amputation rationale Medical, Surgical Management
Treatment for disorder influencing healing
Level at which limb is amputated
Amputation methods: Open (guillotine); Closed (flap)
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Figure 61-8

21. Amputation 21/24 Pg 984 Medical, Surgical Management (Cont’d)
Arm amputation
Leg amputation
Attachment of temporary prosthesis to plaster shell
Custom-made conventional prosthesis
Types of
prostheses
Shoulder harness,
cables, and hook
Semifunctioning
cosmetic hand
Myoelectric arm

22. Immediate Complications
Amputation
Medical, Surgical Management (Cont’d)
Complications /24 Pg 985
Postoperative
Complications
Immediate Complications
Hematoma
Hemorrhage
Infection
Pain
Late Complications
Chronic Osteomyelitis
Causalgia
Phantom Limb
Phantom Pain

23. Amputation 23/24 Pg 985 Medical, Surgical Management (Cont’d)
Phantom limb; Phantom pain
Potential phenomenon
Physiologic response
Rehabilitation
Factors influencing amputee success
Maintain realistic expectations
Nursing Management

24. pkwilliams@DNI.edu 25/25 Pg 988
NCLEX Questions Pg
End of Presentation
By:
P.K. Williams, RN
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