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Med Surg Final

fractures, amputation, casts, and hip replacement

How should you position a pt who had an amputation? Pt should lie on abd (prone) for 30 minutes 3-4 times a day, and position the hip in extention. Have pt avoid sitting in a chair for more than an hour with hips flexed, or having pillow under surgical extremity.
What is phantom limb pain? A sensation of the amputated limb that persists & is unpleasant or painful. It is more common in pts who had chronic limb pain before surgery, rather than a traumatic incident. The pt reports an intense burning, crushing, or cramping in the removed limb.
What are the seven types of fractures? Tranverse, Spiral, Greenstick, Comminuted, Oblique, Pathologic, and Stress
What is a tranverse fx? A fx in which the line of the fx extends across the bone shaft at a right angle to the longitudinal axis.
What is a spiral fx? A fx in which the line of the fx extends in a spiral direction along the shaft of the bone.
What is a greenstick fx? An incomplete fx with with one side splintered and the other side bent.
What is a comminuted fx? A fx with more than 2 fragments, and the smaller fragments appear to be floating.
What is a oblique fx? A fx in which the line of the fx extends in an oblique direction.
What is a pathologic fx? A spontaneous fx at the site of bone disease.
What is a stress fx? A fx that occurs in normal or abnormal bone that is subject to repeated stress, such as from jogging or running.
What are the 4 classifications of fractures? Open (skin is broken), Closed (skin is intact), Complete (break is completely through the bone), and Incomplete (fx occurs partly across the bone shaft but the bone is still in one piece)
What are some complications of fractures? Infection, compartment syndrome, venous thromboemolism, and fat embolism syndrome (FES)
What is compartment syndrome? A condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space. It is characterized by excessive pain, pallor, parasthesia, paralysis, & pulselessness
What is FES? A fx complication characterized by the presence of systemic fat globules from fx that are distributed into tissues & organs after a traumatic skeletal injury. It is uncommon, but life-threatening.
What is open reduction internal fixation (ORIF)? The correction of bone alignment through a surgical incision, which uses the internal fixation of the fx with the use of wires, screws, pins, plates, intramedullary rods, or nails
What are 4 common fractures? Colle's fx, Hip fx, Pelvic fx, and Humerus fx
What is injured in a pt with a Colle's fx? distal radius
What are complications that can occur with casts? cast is too tight causing decreased circulation, cast syndrome (when body jacket cast is too tight and it compresses the superior mesenteric artery against the duodenum), constipation due to decreased pt activity, and DVT & pulmonary emboli
How should you position a pt who just had a hip replacement? Instruct pt to lie supine & prone, avoid turning on the affected side until approved by surgeon, & avoid extreme hip flexion **pt is out of bed to ambulate on 1st postop day**
What should you teach a pt who just had a hip replacement? DO NOT force hip into adduction, internal rotation, or greater than 90 degrees of flexion (sitting low). DO NOT cross legs at knees, put on own shoes or stockings until 6 weeks after surgery w/o adaptive device, or sit on chairs w/o arms
A pt just had a hip replacement. What are some precautions you should teach the pt to take? Use elevated toilet seats & chair alterations, keep knees apart w/ abduction pillow, avoid bending over, tub baths & driving aren't allowed for 4-6 weeks, & inform dentist of prosthesis before dental work (for prophylactic antibiotics)
Created by: Ariel H