1 / 43

Comprehensive Guide to Post-Fracture Rehabilitation: Principles and Interventions

Learn the principles of rehabilitation after fracture, joint replacement rehab, amputation rehab, nurse's role, interventions for arthritis, and more. Gain insights into fractures, types, surgeries, complications, amputations, and stump care. Discover desired outcomes and general rules for rehabilitation.

witter
Download Presentation

Comprehensive Guide to Post-Fracture Rehabilitation: Principles and Interventions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Muscle/Skeletal Rehabilitation Lesson #2

  2. Objectives • Identify the principles of rehabilitation after a fracture • Describe arthroplasty and teaching for the patient in rehabilitation after a joint replacement • Describe the role of the rehab nurse in fracture and arthroplasty rehabilitation • Describe amputation rehabilitation • State the interventions by the rehab nurse that can help the patient with arthritis to improve functional abilities

  3. Few Statistics • Over 10 million people in USA have osteoporosis • 1.5 million fractures are credited to osteoporosis • 350, 000 hip fractures included • More than 70% of knee/hip replacements from osteoarthritis

  4. Prohibits Surgery • Bone infection • Severe osteoporosis • Uncontrolled medical problem

  5. DesiredPost-Fracture Rehab Outcomes • Normal position healing • Full ROM to joints around fracture • Normal strength returns • Prevent complications

  6. General Rule • A fracture will require immobilization of the joint both above and below the fracture site during the healing process

  7. Types of Fractures Muscle/Skeletal Rehab Nursing

  8. #1 Stable fracture

  9. Stable Fractures • Require very little treatment • Rehab course begins as soon as initial symptoms of fracture subside. • Perform progressive ROM exercises 3-4 days post fracture • Progressive strengthening of fracture 3rd of 4th week post fracture • Example: • Radial Head Fracture • Non displaced ulna fracture

  10. #2 Moderately stable fracture • Requires some form of immobilization yet allows movement of the joints nearest fracture

  11. #2 Moderately Stable Fracture

  12. #3 Unstable Fracture

  13. #4 Grossly Unstable Fracture • Can’t be immobilized • Requires surgical intervention • Requires plaster or fiberglass cast • May require a cast or air brace • Examples: • Hip Fractures • Femur Fractures

  14. #4 Grossly Unstable Fracture

  15. Unstable Fracture Advantages and Disadvantages Advantages Disadvantages • Early mobilization • Early return to general mobility • Sometimes early protected weight bearing • Decreased risk with spinal anesthesia • Newer smaller incisions • Increased risks w/general anesthesia (elderly) • Increased risk of infection • Risk of interference w/the natural physiology of healing process..(screws may loosen, unresolved pain)

  16. #5 Comminuted Fracture • External Fixator

  17. External Fixators • Used for complicated, very commuted and grossly unstable fractures • Usually have a lot of soft tissue damage and edema

  18. Basic Principles of Rehab post fracture • #1 All Joints not requiring immobilization should be mobilized • #2 Gait Training/weight bearing as soon as possible • #3 Mobilization of the fracture area as soon as stability has been achieved • #4 Use of Local Help Techniques for pain and muscle spasms • #5 Muscle Strengthening as soon as fracture stabilized • #6 Perform ROM Exercises • #7 Strengthening Exercises

  19. Systemic Complications of Fractures • Atelectasis and Pneumonia • Infection • GU stasis • Deep Vein Thrombosis • Fat Emboli • Pulmonary Emboli • Systemic problems of Immobility • ARDS

  20. Local Complications of Specific Fractures • Non-Union • Mal-Union • Infection-Osteomyelitis • Stiffness

  21. Surgeries • Arthroplasty • Defined • Two Goals • Candidates for surgery • Our focus: • Hip • Knee

  22. Hip Abductor Wedge

  23. Complications of Hip Dislocation • Causes • S&S of dislocation • Five “P’s” neurovascular check • Nursing responsibility • AnteriorPosterior

  24. Knee Replacement • Purpose • When? • Critical pathway • Other replacements

  25. Role of Rehab Nurse in Fractures and Arthroplasty • Routine cast care • Monitor the extremity regularly • Provide/teach skin care/pin site care • Position properly • Supervise and monitor client’s weight bearing • Perform ROM as PT directed • Provide and encourage ADL training • Monitor for systemic and local complications • Monitor and perform pain management

  26. Amputations

  27. Amputation Rehabilitation • Children do well for injuries requiring rehab • Indications for an amputation is when the limb is no longer of any use • Severe trauma • Thermal injuries • Infections • Tumors • Pain • Severe circulatory problems) • Goal with amputations

  28. Level of Amputation • Severity of soft tissue damage • Assessment • Vascularity of the tissue • Best level of function

  29. Types of Amputations

  30. Stump Healing • Care and inspection • S&S of infection • W/C support • Expected outcomes

  31. Stump Shrinking • Purpose • Dressings

  32. Preventing Contractures Principles • #1 Prevent hip flexion and external rotation of stump • #2 Promote prone position • #3 Encourage crutch walking ASAP • #4 Avoid prolong sitting in W/C, bed, chair • #5 Patient performs resistance strengthening exercises on other limb

  33. Amputee Mobility Training

  34. Problem/Complications of Amputees • Skin problems • Atrophy • Phantom Limb Sensation • Phantom Pain • Interventions • Desensitizing techniques • Alternative methods to help phantom pain • Edema • Bony overgrowths

  35. Rehab Nurse Role in Care of Amputation • Appropriate care to enable the patient to wear a prosthetic • Ensure appropriate care of stump healing/shrinking • Prevention of contractures

  36. Arthritis Rheumatoid Arthritis Osteoarthritis

  37. Arthritis Rheumatoid Osteoarthritis • Chronic/ ?autoimmune • Systemic and symmetrical • Periods of exacerbation/remission • Onset: insidious • S&S • Treatment: • Drugs, rest, Protect, change environment • Degenerative • Unknown cause • Localized and asymmetrical • Can’t function with ADLs RT pain • S&S • Treatment: Wt loss • Drugs, rest, ROM, heat, Environment changes

  38. Arthritis Problems

  39. Arthritis Rehabilitation Nurses Role • Minimize morning stiffness • Manage environment • Provide /maintain stress free environment • Encourage/support: • proper positioning • comfort measures

  40. Summary • So what did I learn? • Name one thing • How you will incorporate it into your nursing practice

  41. References http://www.sportmedstore.com/products/images/POST-OP_WOUND_CARE_FRACTURE.jpg http://www.mdguidelines.com/images/Illustrations/fr_fem_n.jpg http://nemsi.uchc.edu/images/image_wristfract1.jpg http://media.summitmedicalgroup.com/media/db/relayhealth-images/radihead.jpg http://www.drfoot.co.uk/pictures/CollesFracture.gif http://www.hmc.org.qa/mejem/sept2003/images/Figure%202%20pg%2044.jpg http://www.ossur.co.uk/library/10461&proc=6/Soft%20Humeral%20Fracture%20Brace.jpg http://www.orthosupersite.com/images/content/ot/201012/ot1210podeszwaF1.gif http://www.irishvetjournal.org/content/figures/2046-0481-62-10-663-3.gif http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/10202.jpg http://teamofmonkeys.com/html/images/a%20Ilizarov%20External%20Fixation%20at%20Bat%20Yam%20Migdal%20Zahav%20Israel%202006%20yfrimer.jpg http://www.the-hospitalist.org/SpringboardWebApp/userfiles/hosp/image/TH_2012_09_pp09_02.jpg http://www.doctortipster.com/4163-deep-venous-thrombosis-treatment-and-prophylaxis.html/lovenox http://hanyhefny.com/images/malunion.jpg

More Related