Orthopedic Surgery

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Orthopedic Surgery

• Deborah Cary, RN, MSN
• Professor of Nursing
• Broward Community College

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Facial Surgery

• Facial fractures
• Assess Airway
• Assess for orbital damage
• Assess Hemorrhage
• FX Mandible
• Surgery Immobilization via
• wiring with screws/plates
• Use arch bars healing 6wks

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Complications Facial Surgery

• Airway obstruction
• Aspiration vomitus

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Nursing Management

• Post-op
• Side lying with head elevated
• Wire cutters or scissors taped head of bed
  for use in emergency
• N/G tube care
• Suction at bedside
• Antiemetics
• Emollients
• Oral hygiene
• Communication
• Nutrition

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AMPUTATIONS

• Review stump bandaging p. 1683
• Review limb care p. 1684

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Joint Surgery

• Joint replacement most common
• orthopedic surgery done older adults
• Relieves pain
• Improves motion
• Corrects deformity
• Debilitating joint pain D/T degenerative
  arthritis is the most common reason for
  arthroplasty

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Hip/knee Arthroplasty

• Causes
• Failed surgery
• Sepsis
• Tumors
• Pagets Disease
• Congenital hip dysplasia
• Varus/ valgus deformities
• Spondyloarthropathies

¼ million annually
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Joint Surgeries

• Synovectomy
• Used for RA
• Osteotomy
• Debridement

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Arthroplasty

• Definition reconstruction or replacement of a
  joint
• Usually done for osteoarthritis (DOA)
• HIP (THA) cemented prosthesis used for older,
  less active

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Hip Arthroplasty

• Repair of the hip joint (intracap
• sular hip fx heal poorly
• Extracapsular Outside the
• joint capsule better prognosis
• Post-op nursing care
• If pinned NO restrictions
• If replacement ball/socket
• Home no stairs, raised toilet seats
• Remove scatter rugs,
  careful

NO -NOs
INTERNAL ROTATION ADDUCTION 90 degree FLEXION
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INTRACAPSULAR
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Total Knee Replacement

• KNEE ARTHROPLASTY
• Immobilization Post-op via
• compression drsg
• Use knee immobilizer
• Knee Extension when ambula-
• lating/ at rest for 4 wks
• Isometric exercises 1st day p.o.
• CPM to knee flexion to 90 degrees

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Athrodesis

• Surgical fusion of a joint
• Relieves pain
• Provides stable yet immobile joint

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Nursing Management

• Assess neurovascular status
• I/O
• Assess for complications
• PAIN management
• Keep legs elevated when in chair
• SCDs

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Nursing Management

• Pre-op teaching
• Post-op reinforcement
• PAIN control
• Discharge Planning
• Review care p. 1688

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Complications of Joint Surgery

• INFECTION
• GM strept/staph
• DVT measures to prevent
• Venous doppler ultrasound to dx DVT

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CTS (Carpal Tunnel Syndrome)

• Compression median nerve under
• carpal ligament
• Most common compression neuropathy
• Occupations with continuous wrist movement

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CTS continued

• DX Phalens test
• Tinels sign Review text
• Prevention Wrist splints
• Ergonomic keyboards
• Change in body position
• Frequent breaks
• RX corticosteroids Surgery