Nursing care of patients

undergoing orthopedic
surgery
Isaac Amankwaa

Introduction
Orthopedics

is a branch of surgery that deals with

conditions of the musculoskeletal system.
Orthopedic surgeons use both surgical and nonsurgical approaches.
Orthopedics cure varied conditions such as
degenerative diseases, tumors and musculoskeletal
trauma.

Indications for surgery

Unstabilized

fracture

Deformity
joint

disease,

necrotic
tumors

or infected tissue,

Types of orthopedic Surgeries

Open

reduction

Closed

reduction

Internal
Bone

fixation.

graft

Types of orthopedic surgeries contd

Arthroplastyrepair
Joint

of a joint;

replacement type of arthroplasty that

involves replacement of joint surfaces with metal

or plastic materials.
Total

joint replacement replacement of both

articular surfaces within a joint.

Meniscectomy:

excision of damaged meniscus

(fibrocartilage) of the knee.

Types of orthopedic surgeries contd

Tendon

transfer movement of tendon

insertion point to improve function.

Fasciotomy

cutting muscle fascia to

relieve constriction or contracture.

Amputationremoval

of a body part

Joint Replacement
Involves

removing a
damaged joint and
putting in a new one.
The Indications
include
severe joint pain
isability
fractures (eg,
femoral neck
fracture)
Joints frequently
replaced include the
hip, knee, and finger

Joint replacement materials

Metal

and high-density polyethylene

materials.
Polymethyl methacrylate (PMMA) used to
cement implants into prepared bone

Nursing Interventions
Preoperative

assessment

Routine preoperative assessment

Hydration status
Medication history
Possible infection
Ask specifically about colds, dental
problems, urinary tract infections, infections
within 2 weeks
Knowledge
Support and coping

Post-operative care
Postoperative

assessment data are compared with

preoperative assessment data to identify changes
and deficits.
Pain
Vital signs, including respirations and breath sounds
LOC
Neurovascular status and tissue perfusion
Signs and symptoms of bleedingwound drainage
Mobility and understanding of mobility restrictions
Bowel sounds and bowel elimination
Urinary output
Signs and symptoms of complicationsDVT or
infection

Needs of Patients with Hip or Knee Replacement

Surgery
Mobility

and ambulation
Patients usually begin ambulation within a day
after surgery using walker or crutches.
Weight-bearing as prescribed by the physician
Drain use postoperatively
Assess for bleeding and fluid accumulation
Prevention of infection
Infection may occur in the immediate
postoperative period (within 3 months), as a
delayed infection (424 months), or due to spread
from another site (more than 2 years)
Prevention of DVT
Patient teaching and rehabilitation
1

Hip Prosthesis

Positioning of the leg in abduction to prevent dislocation of

the prostheses
Do not flex hip more than 90
Avoid internal rotation
Protective positioning
Hip precautions

Avoid bending forward when seated in a chair.

Avoid bending forward to pick up an object on the
floor.
Use a high-seated chair and a raised toilet seat.

Use of an Abduction Pillow to Prevent Hip

Dislocation After Total Hip Replacement

Potential Complications
Postoperative
Hypovolemic

shock

Atelectasis
Pneumonia
Urinary

retention
Infection
ThromboembolismDVT or PE
Constipation or fecal impaction

Interventions
Muscle

setting, ankle and calf-pumping exercises

Measures to ensure adequate nutrition and
hydration
Note: Large amounts of milk should not be given
to orthopedic patients on bed rest
Skin care measures including frequent turning and
positioning
Follow physical therapy and rehabilitation
programs
Encourage the patient to set realistic goals and
perform self-care care within limits of the
therapeutic regimen
1

Interventions

Preventing atelectasis and pneumonia

Encourage coughing and deep breathing exercises

Use of incentive spirometry

Constipation

Monitoring of bowel function

Hydration
Early mobilization
Stool softeners

Patient teaching

Osteogenesis Imperfecta
Also

known as brittle-bone disease.

Is a genetic (inherited) disorder
characterized by bones that break
easily without a specific cause

Etiology
Genetic

mutation

Pathophysiology
Can

result from autosomal dominant or recessive

inheritance.
Mutation change occurs in the DNA (the genetic
code) within a gene that makes collagen, a major
component of the connective tissues in bones,
ligaments, teeth, and the white outer tissue of the
eyeballs (sclera)
The reticulum fails to differentiate into mature
collagen or causes abnormal collagen development
Leading to immature, coarse bone formation and
cortical bone thinning
Result in fragile bones that break easily

Signs and Symptoms

Multiple

fractures at birth
Bilaterally bulging skull
Triangular shaped head and face
Prominent eyes
Blue or gray tinted sclera
Pain and bone swelling
Loss of function
Thin, translucent skin
Teeth that breaks easily

Signs and Symptoms

Breathing

problems
Delayed walking
Scoliosis as the child grows
Tinnitus
Hearing loss
Kidney stone
Urinary problems

Diagnostic investigations
Family

history and characteristics features

such as blue sclera or deafness.
Complete medical history and physical
examination.
Skin biopsy to determine the amount and
structure of collagen.
X-ray showing evidence of multiple old and
new fractures and skeletal deformities.
Bone Mineral Density (BMD) test

Nursing Interventions
Support

limbs, do not pull on arms or legs or

lift the legs to prevent more fractures or
deformities.
Position the patient withcare.
Check the patients circulatory, motor, and
sensory abilities.
Provide emergencycareof fractures.
Observe for signs of compartment syndrome.
Encourage diet high in protein and vitamins
to promote healing.

Nursing intervention
Encourage

fluids to prevent constipation, renal

calculi, and urinary tract infection.
Providecarefor client with traction, with cast, or
with open reduction.
Encourage mobility when possible.
Administer analgesics as prescribed.
Teach the patient preventive measures.
Monitor hearing needs.
Aggressively teach all upper respiratory infections
including

Complications
Pressure

ulcer
Pneumonia
Constipation
Urinary stasis
Infection

OsteomyelitisDefinition

Osteomyelitis

is the Inflammatory

process within the bone with an

infectious cause.
Bone

treat

infections are more difficult to

Pathophysiology

Causative organisms include: Staphylococcus aureus (most

common) Proteus, Pseudomonas species and Escherichia coli.
The initial response to infection is inflammation, increased
vascularity, and edema.
After 2 or 3 days, thrombosis of the blood vessels occurs in the
area, resulting in ischemia with bone necrosis.
The infection extends into the medullary cavity and under the
periosteum and may spread into adjacent soft tissues and joints.
Unless the infective process is treated promptly, a bone abscess
forms.
The resulting abscess cavity contains dead bone tissue (the
sequestrum), which does not easily liquefy and drain. Therefore,
the cavity cannot collapse and heal, as occurs in soft tissue
abscesses. New bone growth (the involucrum) forms and
surrounds the sequestrum. Although healing appears to take place,
a chronically infected sequestrum remains and produces recurring
abscesses throughout the patients life. This is referred to as chronic