Amputations Stump care (Residual Limb Care ) After Surgery
1.Do NOT elevate limb NCLEX TIP
2. keep limb in dependent position
When getting fitted for prosthesis, to the extremity we wrap in a figure 8 pattern to prevent restriction of blood flow.
3. Phantom limb pain- Strong persistent pain that comes from the missing part of the limb, AKA the operative site.
Amputations Discharge Teaching?
Residual limb Daily Care NCLEX TIPS
1. Assess:Redness & irritation
2. Wash limb every day with soap & water
3. Exposed to air
Lay on stomach "Prone" position NCLEX TIPS
4. 30 minutes x 3 times per day = to prevent hip contractures where joints get stiff in the hip.
5. push stump into the bed = to increase circulation to the stump.
6. Limp socks and wraps= we make sure to keep clean and dry.
Fracture
Closed fracture:
Does not break skin
Open fracture "compound":
Skin surface broken. Leads To MORE INFECTION because of the skin is broken
Needs TO KNOW WHEN WAS THE LAST TIME THEY GOT A Tetanus Vaccines
Complete fracture- Where the bone is broken all the way through
Incomplete fracture "Greenstick"- Only goes partially through the bone
Spiral Fracture- This results from a twisting motion, so it's common in child abuse. These are typically reported to the authorities for further investigation.
Oblique Fracture- A fracture at an angle
Compression fracture- Known as an "Impact fractur"- Where bones are compressed like after high fall or even a jump
Crush or Crushing "Compression" Fracture - Where bones get crushed under a heavy object.This one places the client at high risk for a Deadly FAT EMBOLISM
Fracture Causes & Risks
1.Bed rest
2.Osteoporosis- Where the bone become very weak and porous with porosis
3. Steroids "-SONE" NCLEX TIPS
-Prednisone= makes the bones so weak
4. Trauma - Falling off a bike
Fracture Sign and Symptoms ?
1.Pain & swelling (bruising)
2. Crepitus- grinding sounds as the bones or cartilage rub together
3. Muscle spasms
Priority finding: NCLEX TIPS
4.Internal Bleeding
-Hypotension
-Tachycardia
-Hematuria - That blood inside the urine
Fracture Sign and Symptoms ?
1.Basilar Skull Fracture
CSF "Cerebrospinal Fluid" (Rhinorrhea)=
-Clear liquid drainage from the nose area. PRIORITY PATIENT
2.Spine fracture (T-6 Or Higher)
Monitor for Neurogenic shock:
- Hypotension-LOOK FOR LOW BP FOR ANY TYPE OF SHOCK
- Bradycardia- IS THE BIGGEST indication for a spinal fracture
- Skin: Pink & dry
3.Mandibular Fracture
- Bleeding and drooling in the mouth
-suction the oropharynx- Done to Protect the AIRWAY
4. Hip Fracture NCLEX TIP
- Shortening of leg on the affected area.
-Muscle spasm around the affected area.
-Ecchymosis on thigh and hip
-Groin & hip pain with weight bearing
Fracture
Buck's Traction - this is used short term before surgery to realign bones in the hip and femur fractures.Where the bones are displaced and we typically see one leg shorter than the other.So this traction pulls back into place the bone that's displaced.we use free hanging weights with pulleys and wheels to just pull that bone back into place and stop the muscle spasm
Fracture Buck's Traction
KEY POINTS
1.Weights: Free hanging at all times
2.Traction ropes TIGHT!
- NOT loose
-NOT resting "On bed or floor"
- Reposition:Hold weights
Its OKAY to loosen the straps when the patient reports it's too tight.
3. Keep limb in neutral position
4. Assess for skin breakdown
5. Neuro Checks on limb: PULSES, MOTOR, SENSATION, AND CAPILLARY REFILL
6. Supine position (Flat) NCLEX TIPS
7.Do NOT ELEVATE HEAD OF BED OVER 25 DEGREE. So no semi-fowlers and High fowlers
Fracture Postoperative care
KEY WORDS
Hip & Femur surgery
- Total Hip replacement
- ORIF "Open reduction internal fixation"- this just means pins and plates and screws are used internally for an internal fixation.
External fixation - just means that the pins and screws are used externally or outside. = This is common with femur fractures.
Fracture Postoperative care
PRIORITIZE THE ORDER
1. BLEEDING
- Hemoglobin Less than 7= HEAVEN
Report to HCP!
-Monitor pulses distal to injury
Hypotension & Tachycardia= This might indicate internal bleeding !
2. INFECTION
-Elevated WBC NCLEX TIPS
(Normal:5,000-10,000) SO WBC level of 17,000 after a total hip or joint replacement we MUST NOTIFY HCP immediately ! this means patient is going into SEPSIS and then into SHOCK.
- Assess drainage: Color, amount & color
- Perform pin care with a sterile solution
-3 TIMES PER Day
3.POSITIONING EDUCATION
Total Hip arthroplasty: NCLEX TIPS
-Abduct legs:Place a pillow between the legs. Always Away From LEGS
-NO crossing legs
- NO leaning forwars (NO Tying shoes)
-NO sitting in chairs (90 degree angle)