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What are bunions and what is the treatment?
- Bony enlargement of a joint of the foot caused by ill-fitting shoes
- Joint then enlarges due to body weight on ball of foot
- Enlargement leads to hallux vargus (lateral drift of big toe resulting in overlapping toes)
- Bunionectomy involves removal of bony growth and realignment with pins
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What are some negative effects of high heal shows?
- Misalignment of the spine
- Bunions
- Shortening of the achilles tendon
- Hammer Toes
- Hallus Vargus
- Morton's neuroma (small tumor in digital nerve of the foot)
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What are the different types of fractures?
- Complete- break across entire width
- Incomplete- break only through park of the bone
- Open/compound & Closed
- Pathologic- spontaneous fracture occurring after the bone was weakened by disease
- Compression-often occurs in spine due to loading pressure on long axis
- Displaced & Non Displaced
- Comminutes
- Oblique
- Spiral
- Impacted (think CTs knee)
- Green stick
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What is ACS? What are the causes and what risks/complications are involved?
- Acute Compartment Syndrome
- Hemorrhage, edema, tight cast causes pain and edema compressing the nerves and vessels inside the muscle fascia
- Results in pain, nerve damage, necrosis, infection, and possible amputation
- Risk for Myoglobinuric syndrome, where renal failure is caused by muscle protein in the blood clogs the renal tubes
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What assessment should be done to assess for ACS? What is the treatment?
- CMS checks compared to contralateral side
- Skin color, pulses, cap refill, temperature distal to site
- Numbness, tingling, sensation, pain
- Movement of fingers, toes
- Treatment is a fasciotomy to relieve pressure
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What is FES? What are the s/s?
- Fat Embolism Syndrome
- Results from fat globules from long bone fracture circulating in blood
- Usually occurs within 2 days of long bone surgery with gradual onset
- First S/S is altered mental status r/t decreased O2
- Dyspnea and chest pain
- Petechia on upper trunk is a late sign
- *resulting PE can be deadly
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What is a delayed union?
- fracture that does not heal within 6 mo
- Causes pain, dysformation and immobility
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What is the emergency care of a fracture?
- CAB and call 911
- Quick assessment for other injuries and assess affected area
- Remove clothing and jewelry to prevent restriction during swelling
- Apply direct pressure
- CMS checks
- Splint and dressing
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What is the difference between a closed reduction and an open reduction?
- Closed reduction is done with manual traction to place bones back together
- General Anesthesia may be used
- Open Reduction Internal Fixation (ORIF) is an open surgery to reduce fracture and apply plates and screws, which can be removed after healing
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What nursing care should be done for casts? What is important to remember about plaster casts?
- CMS checks distal to cast to assess for compartment syndrome
- Assess for infection under cast
- Bivalve cast may be used near end (open on sides and held with elastic wrap to splint)
- Elevate the cast above heart to reduce swelling
- Apply ice to cast for first 24-48 hrs to reduce swelling
- Plaster casts tak 1-3 days to air dry, cannot get wet, and must be held with palms when wet
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What is bucks traction?
- Skin traction that pulls to fixate and align bone ends prior to surgery. Like a boot that pulls with weight over end of bed
- Can also be used for candidates who cannot have surgery or to treat muscle spasms prior to surgery
- Add 5-10lb weight and keep weight off floor
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Describe External Fixation Devices
- Pins go directly through skin to bone for fixation of limbs, pelvis
- Done under general anesthesia
- Frame can be adjusted as needed by MD
- Allows to direct site of skin and pin sites
- Site should drain clear fluid for 3 days
- Pain management is important and starts in the PACU
- Risk for disturbed body image
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What is a bone graft?
- Cadaveric bone or autograft bone from pelvis used to supplement bone ends, lengthen bones, or replace comminuted bone
- Graft is wired or internally fixated to surrounding bone
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What are the different kinds of hip fractures? What is the treatment?
- Classified by location
- Intracapsular: inside joint capsule. Capital, subcapital, femoral, femoral neck
- Extracapsular:outside joint capsule. Intertrochanteric, subtrochanteric
- Treated with Open Reduction Internal Fixation
- Bedrest for clients who cannot tolerate surgery
- fixation may be used prior to surgery to prevent muscle tremors
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What are the risk factors for a broken hip? What is the greatest cause?
- Falls are the biggest cause, with osteoporosis being the greatest risk factor
- Poor vision, hearing, poor lighting, uneven surfaces
- Weakened gait, balance, or muscle strength
- Loose carpets, throw rugs, and clutter in the house
- Polypharmacy
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What s/s are found with a hip fracture? What is the diagnostic test used for diagnosis?
- Pain over upper thigh or groin
- Affected leg shorter than unaffected leg
- External rotation of affected leg
- Diagnosis made by xray
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What are the different kinds of amputations?
- Toes
- Chopart- mid foot amputation
- Syme- foot removed, ankle remains
- Below the Knee Amputation (BKA)
- Above the Knee Amputation (AKA)
- Hip Disarticulation- removal of the hip joint, more common in younger pts as a last resort for cancer, osteomyelitis, or trauma
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What nursing considerations need to be taken preop to an amputation?
- Grieving for anticipated loss of limb
- At risk for systemic infection, reduce risks
- Routine preop consents and procedures for surgery
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What nursing considerations need to be made for postop of an amputation?
- Assess for Hemorrhage
- Assess for Infection at site and provide adequate wound care
- Assess for phantom limb pain (PLP)
- PLP can be treated with tricyclic antidepressants, antiepileptics, narcotics, NMDA nerve blocks, mirror therapy, virtual therapy
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