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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. Nursing Interventions for Patient in a Cast.

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ms care modalities

MS Care Modalities

Connie K. Cupples, MS, MSN, RN

care modalities
Care Modalities
  • 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
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
nursing interventions cont d
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
potential complications for patient in a cast
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
teaching the patient with a cast home care
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
management of patient in arm cast
Management of Patient in Arm Cast
  • Elevate immobilized arm
  • Sling used during ambulation
  • Neurovascular checks – observe for Volkmann’s contracture
management of patient in a leg cast
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
nursing interventions with a patient in a body or spica cast
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
managing pt with splints braces
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
nursing interventions for pt with an external fixator
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
nursing interventions with skin traction
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
nursing interventions with a pt in skeletal traction
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
questions
QUESTIONS
  • 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
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
teaching pt to avoid hip 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
nursing interventions cont d1
Nursing Interventions cont’d
  • Observe wound drainage (expect 200-500ml in 1st 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
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
questions1
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.
good bye and good luck
GOOD BYE AND GOOD LUCK
  • Have a blessed day!

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