N201 Orthopaedic

• Common complications specially in the elderly, managing pain

  -       Mild discomfort and decreased ability to perform activities of daily living

  -       Chronic pain

  -       Immobility

  -       Decreased muscle mass and strength 

  -       Loss of elasticity in ligaments, cartilage

  -       Joint problems

  -       Decreased bone density 

  -       Osteopenia

  -       Osteoporosis
• Orthopedic key assessments 

  •       Focused assessment:

  •       Airway Breathing Circulation always first!!!!

  •       Neurovascular assessment

  •       Peripheral Vascular Assessment

  •       Cap refill

  •       Colour

  •       Pulses

  •       Edema

  •       Warmth

  •       Peripheral Neurological Assessment

  •       Sensation

  •       Motor

  •       Function

  •       Pain
• Hip precautions:

  -       No greater than 90 degrees

  -       No crossing legs 
• Orthopedics


  The branch of medicine concerned with the treatment of injuries and disorders of the musculoskeletal system
• Orthopedic team in the surgical setting

  • Medical/Surgical
  • Perioperative
  • PeriAnesthesia
  • Orthopaedics
• Age-Related Considerations: the Musculoskeletal System

  • Effects of musculoskeletal changes range from mild discomfort and decreased ability to perform activities of daily living (ADLs) to severe, chronic pain and immobility
  • Decreased muscle mass and strength; loss of elasticity in ligaments, cartilage; joint problems; decreased bone density
  • Osteopenia and osteoporosis
• Analyze assessment data and diagnostics utilized in the diagnosis, treatment and monitoring of musculoskeletal trauma


  1. Subjective data

  2. Objective data

  3. Physical examination

  4. Inspection

  5. Palpation

  6. Motion

  7. Muscle-strength testing

  8. Measurement

  9. Reflexes
• CT scan to be perform sometime today to diagnose a possible hip fracture
• Goal of care in orthopedics

  • Prevent Complications
  • Promote return of function
  • Promote adaptation
• Nursing Interventions: Post Ortho Surgery

  1. NVS on admission to unit, then q1 x1 and then q4 x 48 hours, then QID (minimum standard)

  2. Musculoskeletal assessment – check MD orders for activity restrictions/orders, equipment needs, teaching re: safety around mobility and transferring

  3. Braces/splints/casts – assess for increased pain, swelling, numbness, loss of function, pulselessness, pallor

  4. Ensure safety equipment available (i.e., cast cutter)

  5. Skin assessment with VS

  6. Device repositioned Q shift (unless contraindicated)

  7. Psychosocial assessment

  8. Discharge planning
• Orthopedics: Key Assessment

  • Airway Breathing Circulation always first!!!!
  • Neurovascular assessment
  • Peripheral Vascular Assessment
  • Peripheral Neurological Assessment
• Diagnostics


  Information acquired through medical interventions such as medical imaging and blood work
• Common diagnostics for most post-operative patients

  • XRAY
  • MRI
• Surgical interventions for osteoarthritis (OA)

  • Goals of surgery – reduce pain, improve mobility, increase quality of life
  • Joints impacted are knee, hip, shoulder, angle and foot
• Fractures

  • Disruption or break in continuity of the structure of bone
  • Majority of fractures from traumatic injuries
  • Some fractures secondary to disease process
• Classification of Fractures

  • Open or closed
  • Complete or incomplete
• Overall goals of fracture treatment

  • Anatomical realignment of bone fragments
  • Immobilization to maintain realignment
  • Restoration of normal or near-normal function of injured parts
• Types of bone fixation

  1. Closed reduction

  2. Open reduction

  3. Includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails
• CAST

  • Temporary circumferential immobilization device
  • Allows patient to perform many normal activities of daily living
• External fixation

  • An external device holds fracture fragments in place, similar to a surgically implanted internal device
  • Attached directly to bone by percutaneous transfixing pins or wires
• Internal fixation

  • Surgically inserted at time of realignment
  • Biologically inert metal devices used
• Surgical Interventions: HIP Arthroplasty

  • OA or trauma
  • Trauma = emergency interventions
  • Cemented Vs not Cemented Joint replacement
  • Complications: Dislocations, Urinary retention
  • Hip Precautions: No flexing past 90 degrees, No midline crossing, 0 adduction
• Surgical Interventions: KNEE Arthroplasty

  Similar complications as hips but less frequent
• Clinical indicators that suggest complications in the surgical patient

  • Neurological and Cognitive function
  • Integumentary and wound
  • GI
  • GU
  • Neurovascular
  • Cardiac
  • Pulmonary
  • Pain
  • Infection
  • Compartment syndrome
  • VTE
  • Fat embolism
• Infection


  Occurs primarily when there is a # on a long bone (femur)
• Atelectasis


  Mostly a concern after a compound (open) #
• Fat Embolus


  Occurs if you don't get your patient moving
• Movement & Sensation Disruption


  Primarily a concern after a displaced # & post op
• How venous thrombosis occurs

  Virchow's Triad: 1. Hypercoagulability, 2. Vessel wall damage, 3. Venous stasis
• VTE, our role in preventing DVT in joint replacement patients

  1. SCDs or sequential compression devices

  2. LMWH or Low Molecular Weight Heparin

  3. IV fluids or oral intake

  4. Mobilize, Mobilize, Mobilize!!!!

  5. Encourage & reinforce leg exercises

  6. Treat pain effectively
• Orthopedic Complications


  • Infection
  • Compartment Syndrome
  • VTE/DVT
  • Anemia
• Nursing Management


  1. Pre Op Preparation

  2. Post Op Care HIP

  3. Post Op Care KNEE

  4. Discharge Planning
• Discharge Planning Considerations


  • Patient education
  • Procedure
  • Monitoring of therapeutic effects
  • Monitoring for complications (S & S)
  • Preparing for home after surgery
  • ADL's
  • Mobility
  • Home support
  • Medications
  • Nutrition
  • TEACH BACK