Critical care nursing
BASICS OF ORTHOPAEDIC, BURNS AND PLASTIC SURGICAL NURSING
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| 2. BASICS OF ORTHOPAEDIC, BURNS AND PLASTIC SURGICAL NURSING.
Introduction Orthopaedic, burns, and plastic surgical nursing are specialized areas within the broader field of nursing that focus on providing comprehensive care and support to patients with specific medical needs. These nursing specialties play an important role in addressing the unique challenges presented by orthopaedic conditions, burn injuries, and plastic surgical procedures. Orthopaedic nursing involves the assessment, treatment, and management of musculoskeletal conditions, including fractures, joint disorders, and spinal injuries. Burns nursing, on the other hand, is dedicated to addressing the complex needs of patients who have sustained burn injuries, ranging from minor burns to life-threatening situations. Plastic surgical nursing centers on patients undergoing plastic or reconstructive surgeries to improve both form and function. Each of these specialties requires a deep understanding of the anatomical and physiological aspects of the human body, as well as specialized skills in wound care, pain management, and emotional support. We will explore the fundamental principles and practices that underlie these areas of nursing, delving into the core knowledge and skills required to deliver high-quality care to patients in these domains. Orthopaedic Nursing Orthopedic nursing is a specialized area of nursing that focuses on the care and treatment of individuals with musculoskeletal conditions, injuries, or disorders. Orthopedic nurses are responsible for assessing, planning, implementing, and evaluating nursing care for patients with orthopedic issues, including fractures, joint replacements, and spinal injuries. Orthopedic conditions encompass a wide range of musculoskeletal issues, disorders, and injuries that affect the bones, joints, muscles, ligaments, and tendons in the human body. They include: fractures, osteoarthritis, rheumatoid arthritis, sprains and strains, tendinitis, herniated disc, scoliosis, osteoporosis, bursitis, carpal tunnel syndrome. Common Orthopaedic Procedures Arthroscopy: A minimally invasive procedure that uses a small camera to diagnose and treat joint problems, such as torn ligaments or cartilage in the knee, shoulder, or other joints. Fracture Reduction and Fixation: The realignment and stabilization of fractured bones through techniques like closed reduction (non-surgical) or open reduction (surgical), often followed by the placement of screws, plates, or rods. Joint Replacement Surgery: Total joint replacement, such as hip or knee replacement, to address severe joint pain and limited mobility due to conditions like osteoarthritis. Spinal Fusion: The surgical fusion of two or more vertebrae in the spine to treat conditions like degenerative disc disease, spinal instability, or herniated discs. ACL Reconstruction: Surgery to repair a torn anterior cruciate ligament (ACL) in the knee, often necessary for athletes and active individuals. Rotator Cuff Repair: Surgical repair of a torn rotator cuff in the shoulder to restore strength and function. Carpal Tunnel Release: A procedure to relieve pressure on the median nerve in the wrist, often performed to treat carpal tunnel syndrome. Tendon Repair: Surgery to repair damaged or torn tendons, commonly in the hand (e.g., for trigger finger) or elsewhere in the body. Laminectomy: The removal of part of the vertebral bone (the lamina) to relieve pressure on the spinal cord or nerves in cases of spinal stenosis or other spinal disorders. Arthroplasty: Joint-preserving procedures, such as hip resurfacing, aimed at restoring joint function and delaying or avoiding joint replacement. Osteotomy: A surgical procedure to reposition or reshape bones to correct deformities or realign joints, often used for conditions like osteoarthritis. Debridement: The removal of damaged tissue or foreign material from a wound or joint, typically in cases of infection or trauma. Bunionectomy: Surgical removal or correction of a bunion, which is a bony bump at the base of the big toe. Meniscus Repair: Surgical repair of damaged meniscus (cartilage) in the knee, often performed during arthroscopy. Fasciotomy: A surgical procedure to release the fascia (connective tissue) in cases of conditions like compartment syndrome. First aid and emergency nursing interventions for orthopedic injuries First aid and emergency nursing interventions for orthopedic injuries or emergencies are essential to provide initial care and prevent further harm. In Fractures: Immobilization: Stabilize the fractured bone and surrounding area by using splints, slings, or other immobilization devices. Elevation: Elevate the injured limb if possible to reduce swelling. Ice: Apply ice to the injured area to reduce pain and swelling, but avoid direct contact with the skin. Pain management: Administer over-the-counter pain relievers if necessary, and monitor for signs of shock. In Dislocations: Immobilization: Keep the dislocated joint immobilized and in the position found, if possible, to prevent further injury. Pain management: Administer pain relief and monitor for signs of neurovascular compromise (such as numbness or color changes in extremities). In Sprains and Strains: R.I.C.E.: Rest, Ice, Compression, and Elevation are key components of first aid for sprains and strains. Immobilization: Use splints or braces if available to support and protect the injured area. In Open Wounds with Fractures: Control bleeding: Apply direct pressure with sterile gauze or a clean cloth to stop bleeding. Prevent infection: Clean the wound with sterile saline or clean water if available, and cover it with a sterile dressing. Immobilization: Stabilize the fractured bone as described above. In Spinal Injuries: Maintain immobilization: If a spinal injury is suspected, keep the head, neck, and spine in a neutral, aligned position and avoid moving the patient. Use a cervical collar if available. Call for professional help: Transport the patient to a medical facility as soon as possible while maintaining spinal precautions. In Compartment Syndrome: Recognize the signs: Be vigilant for signs of increasing pain, swelling, numbness, and decreased pulses in the affected area. Elevation and reassurance: Elevate the limb to the level of the heart and reassure the patient while seeking immediate medical attention. Nursing Assessment and Care for Orthopedic Patients Nursing assessment and care for orthopedic patients are vital for promoting their recovery and well-being. These patients often have musculoskeletal conditions or injuries that require specialized attention. 1. Initial Assessment: Obtain a thorough medical history, including the mechanism of injury or the onset of symptoms. Assess the patient's pain level, location, and quality. Perform a comprehensive physical examination, paying attention to the affected area, looking for deformities, swelling, discoloration, and assessing neurovascular status. Evaluate the patient's range of motion and functional abilities. Document any pre-existing musculoskeletal conditions, comorbidities, or medications. Assess the patient's mental and emotional state, as musculoskeletal issues can impact mental health. 2. Pain Management: Administer prescribed pain medications as ordered and assess their effectiveness. Use non-pharmacological pain management techniques such as positioning, ice or heat therapy, and distraction. Monitor for signs of inadequate pain control or potential opioid-related side effects. 3. Immobilization and Alignment: Ensure the injured area is immobilized to prevent further injury. Maintain proper alignment of fractures or dislocations as per the physician's instructions. Use splints, casts, braces, or traction devices as needed. 4. Neurovascular Assessment: Regularly assess circulation, sensation, and motor function in the affected limb. This involves checking pulses, capillary refill, temperature, and the patient's ability to move and feel in the area. Report any signs of compromised neurovascular status promptly. 5. Skin and Wound Care: Monitor skin integrity, particularly in patients with immobilization devices, to prevent pressure ulcers. Check for any signs of infection or skin breakdown at surgical incision sites. Ensure appropriate wound care, dressing changes, and incision care as per physician orders. 6. Mobility and Rehabilitation: Encourage early mobility as appropriate to prevent complications like muscle atrophy and joint stiffness. Collaborate with physical and occupational therapists to develop and implement rehabilitation plans. Teach patients about safe mobility techniques and exercises. 7. Medication Administration: Administer medications as ordered, including antibiotics for surgical patients and medications for pain management. Monitor and educate patients about potential medication side effects. 8. Patient Education: Provide detailed information about the patient's condition, treatment plan, and expected outcomes. Teach patients how to care for immobilization devices, manage pain, and perform exercises. Emphasize the importance of compliance with medical instructions. 9. Emotional Support: Address the psychological impact of musculoskeletal conditions and injuries. Offer emotional support and encourage open communication. Refer patients to mental health professionals when needed. 10. Collaborative Care: Work closely with the healthcare team, including orthopedic surgeons, physical therapists, and occupational therapists, to provide comprehensive care. 11. Nutrition: Good nutrition plays an important role in recovery from planned orthopaedic surgery or traumatic injury. In the orthopaedic patient, poor nutrition can delay wound healing and fracture repair, increase the risk of infection, decrease muscle strength, lead to the development of constipation and ultimately delay recovery. Nutritional status of an orthopaedic patient is an important determinant for bone health. Calcium, Vitamin D, Vitamin C and a Vitamin K are some important micronutrient for orthopaedic patients. Common orthopedic assistive devices The nurses’ role is to teach patients the proper way of using these devices Crutches: Underarm Crutches: Placed under the arms and used to support and balance a person with lower limb injuries. Forearm Crutches (Lofstrand Crutches): Feature cuffs that encircle the forearms and are often used by individuals with more upper body strength. Walkers: Standard Walker: A metal frame with four legs and rubber tips, providing stability and support during walking. Rollator Walker: Similar to a standard walker but equipped with wheels and hand brakes for easier mobility. Canes: Single-point Cane: Provides additional support while walking and is often used for balance assistance. Quad Cane: Has a four-pronged base for added stability and support. Orthopedic Braces: Knee Braces: Designed to stabilize and support the knee joint, commonly used after injuries or surgery. Ankle Braces: Help with ankle stability and can be used for various conditions, such as sprains. Wrist Braces: Provide support to the wrist and are often used for conditions like carpal tunnel syndrome. Back Braces: Offer support and alignment to the spine for various back-related issues. Orthopedic Shoe Inserts (Orthotics): Custom-made or over-the-counter shoe inserts designed to address specific foot or gait problems, like arch support or cushioning. Wheelchairs: Manual Wheelchairs: Propelled by the user or a caregiver, providing mobility for individuals with lower limb disabilities. Powered Wheelchairs: Electrically powered for those with limited upper body strength or mobility. Scooters: Motorized scooters for individuals with mobility challenges, designed for both indoor and outdoor use. Leg Braces: AFO (Ankle-Foot Orthosis): Supports and stabilizes the ankle and foot, often used for conditions like drop foot. KAFO (Knee-Ankle-Foot Orthosis): Extends from the ankle to the thigh, providing support and control for knee and leg conditions. HKAFO (Hip-Knee-Ankle-Foot Orthosis): Covers the hip, knee, and ankle, assisting individuals with hip instability or leg paralysis. Cervical Collars: Support the neck and cervical spine, often prescribed after neck injuries or surgery. Compression Stockings: Graduated compression stockings promote blood flow and can help manage conditions like deep vein thrombosis (DVT) or varicose veins. Cervical Traction Devices: Used to provide traction to the cervical spine and alleviate neck pain and stiffness. Prosthetic Limbs: Artificial limbs designed to replace missing or amputated body parts, such as arms or legs. Orthopedic Splints: Custom-made or prefabricated splints designed to immobilize or support specific joints or body parts. Rehabilitation in Orthopedic Nursing Orthopedic nurses work closely with orthopedic surgeons, physical and occupational therapists, social workers, and other healthcare professionals to ensure a comprehensive and well-rounded approach to care. Rehabilitation in orthopedic nursing is a comprehensive process that focuses on helping patients recover from musculoskeletal injuries, surgeries, or conditions. It plays a crucial role in restoring patients' physical, psychological, and social well-being. This rehabilitation journey begins by setting specific goals in collaboration with the patient, taking into account their unique condition and treatment plan. Orthopedic nurses work closely with patients to monitor and manage pain, using a combination of pharmacological and non-pharmacological approaches. Physical therapy is an essential aspect of rehabilitation. Physical therapists collaborate with orthopedic nurses to design tailored exercise programs. These exercises aim to improve muscle strength, joint flexibility, and overall physical capabilities, addressing the patient's specific orthopedic condition. Pain management ensures that pain doesn't hinder this rehabilitation process. Occupational therapy focuses on enhancing the patient's ability to perform daily activities and tasks. Occupational therapists work on improving fine motor skills and helping patients adapt their environment to their needs, enabling them to carry out activities like dressing, cooking, and personal care more independently. Orthopedic nurses provide patients with information about their condition, the importance of following their treatment plan, and safety precautions. They guide patients on the use of assistive devices, proper posture, and ways to prevent further injuries. Orthopedic nurses also assist patients in selecting and using orthotic devices such as braces, splints, and crutches. They ensure these devices fit properly and function effectively to aid in the rehabilitation process. Orthopedic nurses also offer emotional support, listen to patients' concerns, address their fears, and help them adapt to the changes in their lives. Monitoring and progress evaluation are ongoing activities in orthopedic rehabilitation. Nurses continually assess and monitor the patient's progress, making adjustments to the rehabilitation plan as needed based on the patient's condition and any setbacks or advancements. Burns Nursing
Immediate and Continuous management of Burns Patient 1. Safety First: Ensure the safety of both the patient and the healthcare team. If the burn occurred due to a chemical or electrical exposure, make sure the source is isolated or turned off. 2. Initial Assessment: Begin with a rapid yet thorough assessment of the patient. Determine the burn's cause, location, depth, and extent. Assess the patient's airway, breathing, and circulation (ABCs). 3. Airway Management: If there is any suspicion of inhalation injury, provide supplemental oxygen, and prepare for intubation if necessary. 4. Circulation and Fluid Resuscitation: Assess the patient's vital signs and establish intravenous access for fluid resuscitation. Use crystalloids like lactated Ringer's or normal saline to replace lost fluids. 5. Pain Management: Administer pain relief, typically through intravenous opioids, as burns can be extremely painful. 6. Burn Cooling: For thermal burns, begin immediate cooling of the burn area with cool, but not ice-cold, water. Continue cooling for at least 10-20 minutes to reduce tissue damage. Do not use ice, as it can cause further tissue injury. 7. Covering the Burn: Cover the burn with a sterile, non-adherent dressing to minimize contamination and prevent infection. 8. Elevating the Burned Area: Elevate the affected limb, if applicable, to reduce edema and minimize pain. 9. Assessing Circulation: Continuously assess the circulation in the affected limb. Monitor for signs of compartment syndrome, such as increased pain, numbness, or reduced pulses. 10. Preventing Hypothermia: Ensure the patient stays warm as cooling the burn can lead to hypothermia. Use blankets or warmed intravenous fluids as needed. 11. Tetanus Prophylaxis: Administer tetanus prophylaxis if there's a risk of contamination, especially for open or dirty wounds. 12. Assess for Inhalation Injury: Be vigilant for signs of inhalation injury, such as coughing, hoarseness, or respiratory distress. If suspected, consult with a physician for a more detailed evaluation. 13. Emotional Support: Offer emotional support to the patient and their family, as burn injuries can be traumatic. 14. Documentation: Accurate and detailed documentation is essential. Record the burn's characteristics, initial treatment, and patient response. 15. Transfer: If the burn is extensive or involves complex medical issues, prepare the patient for transfer to a specialized burn center. Consult with a burn specialist as needed. 16. Preventing Infection: Minimize infection risk by adhering to strict infection control protocols and using sterile techniques during wound care. 17. Ongoing Assessment and Monitoring: Continuously monitor the patient's condition, vitals, and response to treatment. 18. Professional Collaboration: Collaborate with other healthcare professionals, such as burn surgeons and respiratory therapists, to ensure comprehensive care. Plastic Surgical Nursing Plastic surgical nursing is a specialized nursing field dedicated to caring for patients undergoing plastic or reconstructive surgery. Plastic surgical nurses assist in both preoperative and postoperative care, monitor surgical sites, provide wound care, and educate patients on the recovery process. They play a crucial role in helping patients achieve the best possible outcomes following plastic surgery procedures aimed at improving aesthetics or function. Plastic surgery procedures generally fall into one of two categories: Reconstructive and Cosmetic. Reconstructive procedures are procedures that repair parts of the body affected by congenital defects, defects that have developed because of disease, or defects caused by an injury. Cleft lip and palate repair, breast reconstructions, craniosynostosis surgery (head reshaping), gender confirmation surgeries (transfeminine/transmasculine), Lymphedema treatment, migraine surgery (chronic headache relief), panniculectomy (body contouring), septoplasty (deviated septum correction), etc. Cosmetic procedures include surgical and non-surgical procedures that enhance and reshape structures of the body to improve appearance and confidence. Examples include mastopexy, liposuction, arm lift, body lift, buttock enhancement, thigh lift, tummy tuck, ear surgery, eye lid surgery, rhinoplasty, facial implants, etc. Conditions that require the use of plastic surgical procedures; Abnormalities that have existed from birth, such as a cleft lip and palate, webbed fingers, and birthmarks. Areas damaged by the removal of cancerous tissue, such as from the face or breast. Extensive burns or other serious injuries. Scars that prevent natural movement. Severe injuries, like cuts or tears over large areas of skin. Nursing responsibilities for patients with plastic surgical conditions Nurses play a crucial role in the care of patients undergoing plastic surgery. In addition to ensuring that they receive quality medical care, they also need to support the patients' emotional and nutritional needs. Educational and Emotional Management: 1. Pre-operative counseling: Pre-operative counseling is critical in preparing the patient for the surgery mentally. Explanation of the surgical procedure, postoperative care, and likely outcomes helps allay the anxieties of the patient, promoting healing. 2. Post-operative Care: Plastic surgery can lead to self-image fluctuations, depression, and anxiety. Nurses can provide counseling and supportive therapy to boost recovery by enhancing their relationship with the patient. 3. Instruction of self-care regimens: Nurses play a significant role in demonstrating self-care techniques that include wound care, use of pressure garments, use of ice packs, and elevation of the operative area to help promote faster recovery, thereby reducing stress to the patient. Nutritional Management: 1. Planning individualized nutrition plans: Patients undergoing plastic surgery require adequate dietary support. The nurse may work with the dietician to design a healthy and well-balanced diet. 2. Monitoring nutritional intake: A nurse may monitor the patient's food and fluid intake, provide emotional and physical support to promote healthy dietary intake in patients. 3. Educating patients on nutritional supplements: a nurse may advise on the use of supplements such as vitamins, minerals, and probiotics, which can enhance the functionality of the immune system, hormonal balance, and wound healing process. 4. Managing prescriptions: Working with the physician, the nurse may oversee the prescription of dietary supplements and medications. Contraindicated treatment/medications in orthopedic, burns and plastic surgical nursing Orthopedic Nursing In orthopedic nursing, there are various contraindicated treatments and medications that depend on the specific patient's condition and medical history. Some general considerations include: 1. Opioid (Morphine) Analgesics is contraindicated in these patients, results in respiratory depression. 2. Anticoagulants should not be administered to patients with active bleeding, including gastrointestinal bleeding, intracranial bleeding, or significant trauma, as they can exacerbate bleeding. In the immediate postoperative period, anticoagulants might be contraindicated to reduce the risk of surgical site bleeding. 3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be contraindicated in patients with a history of gastrointestinal bleeding, renal impairment, or allergies Burns Nursing 1. Using ice or very cold water can further damage burned tissue and is generally not recommended. 2. Neomycin can cause allergic reactions in some individuals and is generally avoided in burn care. Antimicrobial dressings are contraindicated for use on patients with known sensitivities to any of the product components. Silver dressings cannot be worn during magnetic resonance imaging (MRI) procedures. 3. It is not recommended to pop or drain burn blisters as this can increase the risk of infection. NSAIDs like ibuprofen can interfere with the body's inflammatory response and may not be appropriate during the acute phase of burn injuries. Plastic Surgery Some health problems can be contraindications to surgery. These include high blood pressure, diabetes, lung or heart disease, bleeding disorders, serious allergies or arthritis. Alcohol, tobacco and caffeine use may also cause problems with procedures and recoveries. Overuse of these substances can decrease blood flow and slow the healing process. Smoking may also reduce the body’s resistance to infections. 1. Medications like aspirin, warfarin, and certain non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding during and after surgery, and they are typically discontinued or adjusted under the guidance of a healthcare provider. 2. Smoking and nicotine products: Smoking can impair the body's ability to heal, so patients are often advised to quit smoking or using nicotine products before and after surgery. 3. Certain antibiotics: Some antibiotics can interact with anesthesia and other medications used during surgery, so the surgeon should be aware of all medications a patient is taking. 4. High doses of vitamin E can also increase the risk of bleeding and should be avoided before surgery. 5. Excessive alcohol consumption: Heavy alcohol use can impair the body's ability to heal and may interact with medications, so it's often recommended to limit or avoid alcohol before surgery. Modern trends in orthopedic, burns and plastic surgical nursing Patient-Centered Care: A shift towards patient-centered care models in orthopedic, burns, and plastic surgical nursing emphasizes the importance of tailoring care plans to meet the individual needs and preferences of patients, fostering a more personalized and empathetic approach to nursing practice. Advanced Wound Management Techniques: Continuous advancements in wound management techniques have led to the development of innovative strategies and specialized dressings that promote effective wound healing and reduce the risk of complications for patients with orthopedic injuries, burns, and post-surgical wounds. Interdisciplinary Collaboration: There is an increasing trend towards interdisciplinary collaboration among healthcare professionals, fostering a comprehensive approach to patient care that integrates the expertise of orthopedic, burns, and plastic surgical nurses, along with other medical specialists. Telehealth and Remote Patient Monitoring: The integration of telehealth and remote patient monitoring technologies has enabled healthcare providers to conduct virtual consultations, monitor patients' progress, and provide ongoing support and education, particularly for those in remote or underserved areas. Pain Management and Rehabilitation Optimization: Nursing professionals in these specialized fields are actively involved in implementing advanced pain management strategies and rehabilitation protocols, emphasizing the importance of holistic care and patient comfort during the recovery process. Emphasis on Patient Education and Empowerment: There is a growing focus on patient education and empowerment, with nurses playing a pivotal role in providing comprehensive information and support to patients and their families, enabling them to actively participate in their treatment plans and make informed decisions about their care. Integration of Technology in Nursing Practice: The integration of technology, such as electronic health records (EHRs), point-of-care systems, and specialized monitoring devices, has streamlined nursing workflows and enhanced communication among healthcare teams, leading to improved patient outcomes and quality of care. Evidence-Based Practice and Research Integration: The integration of evidence-based practice and ongoing research findings into nursing interventions and clinical decision-making processes has enhanced the quality of care and contributed to the advancement of best practices in orthopedic, burns, and plastic surgical nursing. Community Engagement and Preventive Education: Nurses are actively engaging with local communities to provide preventive education and promote awareness about injury prevention, wound care, and overall health and wellness, aiming to reduce the incidence of orthopedic injuries, burns, and surgical complications through community-based initiatives. Medical monitoring systems: Many patients now use wearable health trackers, like smart watches and bands, that collect information such as heart rate and activity levels. Orthopedic physicians can use wearable monitoring data to better understand their patients’ health needs. Download 98.49 Kb. Share with your friends:
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