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Orthopaedic common disease care plan

Updated: 2019-09-06

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Orthopaedic nursing of common diseases_Clinical Medicine_Medical and Health_Professional materials. A [Common nursing diagnosis / problems] 1. Potential complications: fracture displacement 2. Program obstruction [Nursing method] Femoral neck fracture to take fracture, traction or plaster fixation related fracture, soft tissue damage or long-term bed related 3. To have skin Impaired integrity 1,

A [Common nursing diagnosis / problems] 1. Potential complications: fracture displacement 2. Program obstruction [Nursing method] Femoral neck fracture to take fracture, traction or plaster fixation related fracture, soft tissue damage or long-term bed related 3. To have skin Impaired integrity 1. Connect the proper position to prevent fracture displacement (1) Brake of the affected limb, fixation of the corrective shoes: Brake of the affected limb, put a pillow between the legs when bedridden, so that the affected limb is abducted and neutral It can be fixed by wearing anti-rotation corrective shoes to prevent external rotation or dislocation of the hip joint. It is suitable to connect the affected limb by lower limb support and skin traction. (2) Lying on a hard bed: Resting on a hard bed, lying on the affected side after the doctor's permission; Avoid changing the position, adduction, external rotation, or hip flexion to prevent displacement of the fracture. (3) Carry the patient accurately: Try to avoid carrying or moving the patient. When it is necessary to move, take care to lift the entire hip joint from the affected limb to prevent joint dislocation or new fractures from forming at the fractured end. 2. Accurate programs for pointing patients (1) Isometric contraction of the quadriceps: Pointing patients to perform isometric contraction of the quadriceps of the affected limb, flexion and extension of the calf joints, and foot programs. Multiple times a day, 5-20 minutes each time, to prevent deep vein thrombosis of the lower limbs, muscle atrophy and joint stiffness. Before and after training, pay attention to assess the feeling, movement, temperature, color and pain, swell and edema of the affected limb. (2) Instruct patients to perform full-scale joint programs and functional exercises on both upper and lower limbs. (3) Hip function training: After performing a total hip arthroplasty for 1 week, help the patient sit on the bedside to perform hip function training. The action should be slow. The program scope ranges from small to large, and the program range and strength Gradually increase; instruct the patient to change the position by using the bed rail. (4) Transfer and walking exercise: Evaluate whether the patient needs assistive equipment to complete daily living, and guide the patient to sit up, move to a wheelchair and walk. Non-surgical patients can gradually sit up in bed after 8 weeks. When sitting up, their legs cannot be crossed. After 3 months, they can use crutches gradually. The affected limb is walking in a non-sinking environment and abandoned after 6 months. walk. Patients undergoing total hip arthroplasty, agreed to get out of bed after 2 to 3 weeks, and instructed the patient to use a walker or walking stick to be properly accompanied by someone; the affected limbs should not be held until the fracture has healed. 3. Prevention and care of pressure ulcers (1) Toilet: Use a special toilet suitable for bedridden patients during bedridden. (2) The connecting beds are clean, dry and level. (3) Help patients to change their positions on time, massage the pressured area and skin care. Two [Common Nursing Diagnosis / Problems] 1. There is normal hip varus 2. There is no active suppository for functional training. [Nursing methods] 1. Connect the correct position of the femoral intertrochanteric fracture. Connect the correct position. Take the pain. Sadness and poor understanding of the disease. 3. Potential complications: pressure ulcer, pulmonary infection, urinary infection, constipation, lower limb Deep venous blood (1) connects the affected limb in a neutral abduction position. If the affected limb is adducted, normal hip varus may occur. (2) After the traction is removed, the affected limb should still be connected for abduction. A pillow is placed between the two thighs when lying flat, and it is impossible to lie on the healthy side when lying sideways. 2. Pointing the patient to accurate functional training (1) Declaring the main function of functional training, so that it can be surrendered to the pain and automatically carry out the training. (2) Control accurate training opportunities and methods. The affected limbs were trained on quadriceps isometric contraction, patella passive program and ankle flexion and extension program and foot program. (3) Tempering should be done step by step. 3. Prevent complications (1) Connect the bed to be soft, clean, dry, and level, change position on time, massage the pressured part, and often rub the body with warm water to prevent pressure ulcers. (2) Encourage the patient to expand the chest, take a deep breath, and cough to exercise lung function. Connected to oral hygiene, the air in room 2 is fresh and the temperature is appropriate to prevent lung infection. (3) Urge patients to drink more water to keep the perineum clean to prevent urinary system infection. (4) Eat a balanced diet and eat more fresh vegetables and fruits to prevent constipation. (5) Helping to show the limbs and massage the muscles to prevent muscle atrophy. Three [Common Nursing Diagnosis / Problems] 1. Program obstruction 2. Inactive function training [Nursing methods] 1. Connect accurate position Clavicle fractures Take it easy to connect Accurate position Related to take pain and sorrow and to understand the disease related parts with 8 characters Bandage or double-circle fixation is used to fix the patient, the connection is invalid and the armpit is not too tight. Patients with local immobilization are advised not to change their lying position casually. 2. Pointing the patient to accurate function training (1) After local fixation, connect the chest to raise the shoulder and lift the posture, various activities of the hand, wrist, elbow joint, shoulder abduction, and back extension, such as doing chest chest, hands with waist Do it. Taboo flexion, adduction and other actions. (2) After lifting the external fixation, start a comprehensive shoulder joint program. At first, the purpose of each target of the shoulder joint is changed. The program range is from small to large, and the number of times is small to large. Then carry out the analysis of the goals of each target, such as the shoulder joint rotation program, the arms to do the boat movement and so on. Four [common nursing diagnosis / problem] supracondylar fracture of the humerus to take a fracture to merge soft tissue damage or fracture 1. Peripheral nerve and vascular function impaired improper fixation. 2. The program interferes with the [care method] 3. The fracture is related to the fixation of the affected limb. 1. Strengthen inspection and nursing to avoid nerve and vascular function obstruction. (1) Pay attention to see if the affected limb can show severe pain, pale and cold hand skin, painful sadness of passive extension of the fingers, weakened or disappeared forearm such as radial artery pulsation, etc. The blood indicates that the physician will be notified as soon as it is detected. (2) Check whether the splints and plaster bandages are properly tightened on time, and adjust in time when necessary to avoid nerve and blood vessel compression and maintain invalid tissue perfusion. 2. In the first week after reasonable function training, avoid the limbs on the affected side. After 1 week, gradually raise head fists, fingers, wrist flexion, and shoulder joints. After 4 to 5 weeks, remove the external fixation and perform elbow flexion and extension. Functional refinement. V [Common Nursing Diagnosis / Problems] Colles Fracture Take local fracture edema or improper fixation of fracture 1. It may be related to impaired peripheral neurovascular function. 2. Lack of knowledge: Lack of knowledge of functional training after fracture. [Nursing method] 1. Reduce swelling and promote blood circulation. (1) Strengthen inspection: Pay attention to the skin color, temperature, swelling and radial artery pulsation of the affected limb. (2) Local braking: prevent wrist joints from supination or pronation. (3) Promote venous return: Support the affected limb with a sling or triangle towel to avoid the hindrance of venous return from sagging of the affected limb. 2. Supply related knowledge to instruct patients to perform ineffective function training. (1) Point the patient at the late stage to perform automatic activities of thumbs and other fingers, make strong fists, and expand and extend five fingers to reduce edema and add venous return. Exercise shoulder and elbow joints at the same time to prevent joint stiffness or muscle atrophy. (2) Carpal dorsiflexion and radial deflection were performed in the second 2 weeks, and forearm twisting was performed at the same time. Six [common nursing diagnosis / problems] Tibial and fibula fractures are taken to merge fractures with soft tissue damage or solid fractures. 1. There is a problem related to peripheral neurovascular function impairment. 2. Potential complications: muscle atrophy, stiff joints. [Nursing method] 1. Maintain the general blood circulation of the affected limb and prevent concurrent osteofascial compartment analysis signs. (1) Strengthen inspection: Pay attention to assess the skin color, temperature, swelling and severe pain of the affected limb. (2) Check whether the fixing elasticity such as splint or plaster bandage is appropriate on time and give adjustment in time. 2. Functional training (1) Promote venous return to prevent muscle atrophy and joint stiffness: In the late and late stages, the isometric contraction of the quadriceps and the passive program of the sacrum are performed; at the same time, the program of the feet and interphalangeal joints. (2) Knee and talar joints: Patients with splint external fixation can perform knee and talar joint programs, but the thighs are twisted in the knee flexion environment to prevent nonunion. After removal of traction or external fixation, follow the doctor's advice to perform flexion and extension exercises from the calf and knee joints and various types of hip joint exercises; gradually walk down. VII [Common Nursing Diagnosis / Problems] 1. Painful and sad joint dislocation. Taking joint dislocation causes local tissue damage and pressure. Dislocation, joint pain, sadness, and braking. Take joint displacement vessels and nerves. Related to external fixation. 2. Program obstruction 3. Vascular and distressed 4. Care methods with impaired skin integrity 1. Relieve pain and sadness 5 (1) When moving the patient, support the affected limb and be gentle. (2) Pointing patients and their families should provide psychological hints, diversion of attention, or corruption therapy to relieve pain. (3) Accurate reduction and fixation in the late stage can relieve or disappear pain and sorrow. (4) Use anesthetic as prescribed by the doctor to promote the patient's comfortable sleep. 2. Proper reset and fixation (1) Reset: Prior to reset, anesthesia is given to alleviate pain and grief, and at the same time, muscles are damaged, which is beneficial to reset. The reset successful mark is the general recovery of the passive program, and the bony mark is restored. (2) Fixation: Declaring to the patient and family members the fixed matters needing attention after resetting. If the pressing time is too long, joint stiffness may occur; if the pressing time is too short, the damage cannot be repaired, and then dislocation is easy to occur; It is usually fixed for 3 weeks. During the period of constant pressing, often check whether the limbs of the patient are accurate; Patients with plaster casts should pay attention to whether the plaster is broken, deformed, or severely polluted. 3, do a good job to see that the displaced bone end can be adjacent to the blood vessels and nerves, causing ischemia and feeling, hindered movement of the affected limb. (1) Check the blood circulation at the end of the affected limb on time. If you notice that the affected limb is pale, chilled, and the aorta pulsation has disappeared, remind the doctor of the possibility of aortic damage. (2) Dynamically observe the feelings and activities of the affected limb to understand the degree of nerve damage and restore the environment. (3) Prevent limbs with impaired skin function. 4. Skin integrity For patients who are fixed by traction or plaster, pay attention to the skin's color and temperature to avoid damage to the skin due to the fixation. [Common Nursing Diagnosis / Problems] 1. Tissue perfusion volume is not related to pelvic fracture, pelvic damage, bleeding and so on. Related to bladder, urethra, intra-abdominal device, or bowel damage. Removal of pelvic fractures is related to program obstruction. 6 2. The type of urination and defecation is very 3, there is impaired skin integrity 4, and the program hinders [care methods] related to taking pelvic fractures. 1. Make up blood volume and maintain general tissue perfusion (1) Check vital signs: Pelvic fractures often merge with venous plexus and arterial hemorrhage, showing hypovolemic shock. Should pay attention to the patient's awareness, pulse, blood pressure and urine output, timely detection and treatment of blood volume insufficiency. (2) Establish an intravenous infusion channel: timely transfusion and rehydration according to the doctor's order, and correct blood volume insufficiency. (3) Timely hemostasis and treatment of intra-abdominal net damage: If the anti-shock treatment and care still fails to maintain blood pressure, notify the doctor in time and assist in preparing for surgery. 2. Maintaining smooth urination and defecation (1) Observation: Pay attention to whether the patient has hard urination, urine output and color; whether there is abdominal contraction and constipation. (2) Catheterization: For those who have difficulty urinating due to urethral damage, urinary catheterization or indwelling catheterization is given, and the care of the urethral orifice and urinary catheter is strengthened; the urinary catheter is connected smoothly. (3) Diet: Inspire patients to eat more foods rich in cooking fiber, novel fruits and vegetables, and drink plenty of water to facilitate smooth stool. (4) Laxative: Compared with patients with constipation, laxatives such as Kaiseluo were given according to the doctor's advice. 3. Skin care (1) Linking personal hygiene and cleanliness: Pay attention to the skin care of bedridden patients, linking the clean, healthy and flat and dry sheets; massaging the pressured parts on time; preventing pressure ulcers. (2) Posture: assist the patient to change the posture, and then lie to the affected side after the fracture is healed. 4. Assist and guide patients on reasonable programs: According to the invariance of fracture and treatment plan, take patients all the way to formulate appropriate training plans and guide their implementation. Patients in the department will be able to fully sink within a few days after the operation. Patients undergoing traction will need to wait for 12 weeks to do so. Patients who have been bedridden for a long time must breathe deeply and perform isometric contraction of limb muscles; multiple times a day, 5-20 minutes each time. Help the patient show the upper and lower joints. After agreeing to get out of bed, a walker or walking stick can be used to make the upper and lower limbs cooperate with the pipe body sink. 7 Nine [Common Nursing Diagnosis / Problems] 1. Painful and sad lumbar disc herniation is related to herniated disc herniation, nucleus pulposus compression, nerve root compression, and muscle spasm. Take pain related to grief, traction or surgery. 2. Program obstruction [care methods] 1. Relieve pain and grief 3. Potential complications: cerebrospinal fluid leakage, urinary retention or infection. (1) Rest: Absolute rest in bed in the acute phase. If the condition is agreed after 3 weeks, you can get out of bed. (2) Posture: supine position, bed head raised 30 <, knees bent, a small pillow at the popliteal fossa. Advise the patient to avoid bending the spine while turning over. (3) Drug analgesia: give the patient analgesics as prescribed by the doctor. 2. Functional training (1) Relieve muscle spasm: For those who are limited by the program due to pain and grief, give the aforementioned method of restraining pain and grief, while applying local heat to relieve muscle spasm. (2) Posture: Connect the patient in the position where the surgical mouth and the suture tension are the smallest. Generally, the patient is supine on a hard bed, lying on a hard board, and the axis is given every 2 hours. 2) On the first day after the operation, perform quadriceps femoris contraction and leg curl lifting, twice per minute, with equal lifting time, and gradually increase the leg lifting range. 3) Back muscle training: follow the doctor's instructions to instruct the patient to train back muscles. Generally starting from 7 days after surgery, first use Feiyan, then use the five-point support method, and then change to the three-point support method after 1 to 2 weeks; 3 to 4 times a day, 50 times each time, gradually add the number of times. 4) Walking exercise: Point the patient to get out of bed on time. Before sitting up, first raise the head of the bed, and then put your legs to the bed, so that the upper body bends. When walking, someone is standing by, and the patient can bear without dizziness and physical strength. Then he can walk and pay attention to safety. 3. Prevention and Nursing of Complications 8 (1) Monitor vital signs, check the feelings of lower limbs, the environment of movement, and compare the healthy side and preoperatively. (2) Posture: After the patient's operation, go to the pillow and lie supine for 6 hours. (3) Enhancing passwords and drainage care: check whether the dressing at the surgical password has penetrated, the amount of exudation, and the color of the exudate; whether there is bulging or hematoma in the password part; check whether the drainage tube is unobstructed and the color of the liquid in the drainage bag the amount. If the light fluid is drawn, and headaches, nausea and other symptoms are present at the same time, consider the possibility of cerebrospinal fluid leakage, and the doctor should be treated immediately, while raising the end of the bed, connecting the supine position for 7-10 days, and curving to the meninges. (4) Avoid urinary tract infections: Those who have a hard time urinating, help urinate on the bed, indwell urinary catheterization when necessary, and strengthen the care of the urinary tract and urinary catheter. (5) Prevention of infection: strengthen the monitoring of body warmth and pulse, look at the secret words of surgery, dressings and drainage fluid color, and have a timely lecture on the doctor; strengthen aseptic technique. Ten [Common Nursing Diagnosis / Problems] 1. Inefficient breathing patterns 3. Program obstruction [Nursing methods] 1. Ineffective gas exchange cervical spondylosis: Cervical spinal edema, bone graft loss, or postoperative neck edema related . Neural root compression, traction or surgery related. 2. Potential complications: recurrent laryngeal nerve, superior laryngeal nerve damage, pulmonary infection, pressure ulcer, or urinary tract infection. (1) Preoperative compliance preparation: Before pointing, the patient should do tracheal exercise to move forward. (2) Bedside preparation after surgery: prepare a sphygmomanometer, stethoscope, oxygen suction and removal, sputum suction and removal, tracheal intubation and tracheotomy bag, for emergency use. (3) Oxygen inhalation is given to patients with ineffective breathing pattern. (4) Closely look at the vital signs and local environment of the operation. Check whether the patient has difficulty breathing, cyanosis, slow response, etc .; check for neck swelling, infiltration of dressing, the amount of exudate, color, and character; etc .; Color. 2. Prevention of complications 9 (1) Check for signs of laryngeal regurgitation and superior laryngeal nerve damage: the patient indicates if he swallows hard, coughs up drinking water, hoarseness, and inarticulate pronunciation, and informs the doctor if there is, and Patients are advised to avoid drinking fast, large mouthfuls of water, and to thicken food as much as possible. (2) Encourage the patient to perform ineffective cough and sputum, and do deep breathing activities; a lot of airway excreta should be inhaled to promote sputum discharge. (3) Linking urination and unblocking: Indwelling urinary catheters, connecting unblocked urinary catheters, strengthening urethral opening and urinary catheterization care. (4) Do basic care: Help the patient to turn over on schedule, and the bed unit is clean and dry. 3. Promote the recovery of patients' feelings and performance. (1) Adopt the appropriate position: generally take the supine position. Anterior surgery patients maintain a slightly forward flexion of the neck. The condition applicant adopts the axis) to observe the patient's and bilateral limbs' feelings and the program environment, and check whether it is contagious or impaired. (3) Strengthening function training: The neck support is fixed for 2 to 3 months. Pointing the patient to pinch a rubber ball, exercise ball or towel with both hands, the fingers perform various types of exercises such as finger pointing, button fastening, etc .; daily exercise of joints and limbs to prevent muscle atrophy and joint stiffness 10 Orthopaedic Nursing Care Plan 11 Table of Contents 1. Femoral neck fractures ………………………………………… 1 1 2. Femoral intertrochanteric fractures ……………………………… ……………… 2 III. Fracture of the clavicle …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……… 3 V. Colles fracture …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 5 seven dislocation ......................................................... 5 eight, nine pelvic fracture ......................................................... 6 Lumbar disc herniation ………………………………………… 8 10. Cervical Spondylosis ………………………………………… 9 12

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