ORIF and post op care for hip fracture

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external fixation
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alternative modality for initial management of fractures. after fracture reduction, the physician makes small percutaneous incisions so that pins can be implanted into the bone -the pins are held in place by an external metal frame to prevent bone movement
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disadvantage of the external fixation device
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pin infection -pin tract infections can lead to osteomyelitis
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what to look for and what to do with external fixations
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1. check pin sites for infection: erythema, drainage, warmth, edema 2. provide pin site care 3. check N/V status: regularly checking pulses and sensation 4. elevate if edema is present 5. assess skin for breaks or signs of irritation
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for some types of fractures, if casts and traction are not approp. or sufficient tx techniques, then what needs to be done
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surgical intervention may be needed to realign the bone
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OPERATIVE PROCEDURES
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1. Open reduction with internal fixation (ORIF) 2. external fixation 3. allows surgeon direct visualization of fracture site -uses metal pins, screws, rods, plates, or prosthetic devices to immobilize the fracture during healing
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fractures of the hip
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1. intracapsular: across the head of femur, fracture occur within hip joint capsule 2. extracapsular: across the trochanter, fracture occur outside the joint capsule
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hip fractures occur more frequently in who
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the age over 65, women than in men bc of osteoporosis
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it’s estimated that 10-20% of pts who have hip fractures will what within 1 year of injury
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will die bc of medical complications caused by fracture or resulting immobility
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s/s of hip fracture
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1. affected leg shorter 2. affected leg will be externally rotated: away from the main axis of body 3. edema, stiffness, bruising in and around hip area 4. pain in hip or groin 5. inability to bear wt on affected extrem. 6. muscle spasm 7. avascular necrosis: displaced femoral neck fractures cause serious disruption of blood supple to femoral head, which results in avascular necrosis of the femoral head
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surgical repair is preferred method for what types of fractures
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of managing intracapsular and extracapsular hip fractures -permits early mobilization and decreased the risk of major complications
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initially the affected extremity may be temporarily what
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temporarily immobilized by buck’s traction until pt’s physical condition is stabilized and surgery can be performed
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purpose of buck’s traction
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relieves painful muscle spasms and is used for 24-48 hrs
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what is involved in ORIF
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intramedullary rod, pins, a prosthesis, or a fixed plate, prosthetic device
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interventions for post op care for hip fracture
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1. monitor VS, I&O 2. supervise resp activities: deep breathing and coughing 3. admin. pain med cautiously! 4. observe dressing and incision for signs of bleeding and infection
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in the early postop period, what should the nurse do?
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There’s a potential for neurovascular impairment, so nurse must assess extremity for: -color -temp -cap refill -distal pulses -edema -sensation -motor function -pain
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after surgery, pt is transferred to orthopedic unit where he’ll be monitored for what complications
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hemorrhagic shock, neurovascular impairment, or fat embolism (a risk in pts c long bone fractures
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provider will order what to prevent DVT and PE
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low molecular wt heparin
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what else can you as the nurse do for this pt?
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manage pain: may have PCA encourage early ambulation and good nutrition maintain fluid balance c IV fluids possible monitor amt and character of drainage from the surgical site monitor and empty and record output of drain: I&O assess VS and monitor H&H
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post op care for hip fracture: what should be prevented
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prevent internal rotation prevent adduction of affected extremity bc these will promote dislodgement of the hip
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hip precautions
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1. place a large pillow or abduction pillow b/w legs when turning. -use pillow for first 8 wks after surgery when lying on good side or supine 2. avoid extreme hip flexion: no more than 90 degrees -keep hip in neutral straight position when sitting, walking, or lying 3. use raised toilet seat 4. place chair inside shower or tub, must remain seated while washing
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notify surgeon is what occurs
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if severe pain, deformity, or loss of function occurs.
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inform dentist if presence of what before dental work
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inform him of presence of prosthesis before dental work so that prophylactic antibiotics can be given
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post op care: early ambulation
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1. first post-op day 2. PT: wt bearing on the involved extremity varies. 3. crutch or walker 4. eval for safe discharge: home vs SNF -hospitalization ranges from 3-4 days

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