Pre/Post Op

• Bone healing


  • Bone injury: Bone fractures and blood vessels within the bone and surrounding soft tissues tear and begin to bleed forming a hematoma
  • Necrotic bone tissue adjacent to the fracture causes an intense inflammatory response characterised by vasodilation, exudate formation and white cell migration to the site
  • Fibrocartilaginous callus formation: Clotting factors within the haematoma form a fibrin network
  • Within 48 hours fibroblasts and new capillaries growing into the fracture form granulation tissue that replaces the hematoma phagocytes begin to remove cell debris
  • Osteoblasts bone forming cells proliferate and migrate into the fracture site forming a fibro cartilaginous callus, the osteoblasts build a web of collagen fibres form both sides of the fracture that unit s to connect bone fragments. Chondroblasts lay down patches of cartilage that provide a base for bone growth
  • Bone remodelling: Osteoblasts continue to form new woven bone which is turned organised lamellar structures of compact bone. Osteoclasts reabsorb excess callus as it is replaced by mature bone. The osteoblasts and osteoclasts respond by remodelling the bone along the lines of force
  • Bony callus formation; osteoblasts continue to proliferate and synthesis collagen fibres and bone matrix which are gradually mineralized with calcium and mineral slats to form a spongy mass on bone. Usually continue for 2-3 months
• Types of fractures

  • Closed – bone is broken but not pierced skin
  • Opened – bone breaks and punctures the skin, creates open wound
  • Transverse – a bone break in a straight horizontal line
  • Spiral – a bone is twisted apart
  • Comminute – a bone broken in at least two places – cause, severe trauma
  • Impacted – a break where the ends are driven into each other - cause – blunt force trauma
  • Greenstick – a break where the bone cracks on one side only
  • Oblique – a break occurs at an angle across the width of the bone
• Compartment syndrome


  The increase in intercompartmental pressure within an enclosed space. This compromises perfusion. Fascia surrounding muscles are inelastic connective tissue coverings unable to expand. Bleeding from inflammatory response causes vasodilation and capillary permeability causing fluids to move into interstitial spaces. This increasing pressure leads to decreased blood flow to distal tissue
• Neurovascular Assessment


  • Pain
  • Paresthesia
  • Pulse
  • Pallor
  • Pressure
  • Paralysis
• Nociceptive pain


  Pain caused by nociceptors (Sensory receptors) in response to tissue damage or injury
• Nociceptive pain

  • Stubbing of toe
  • Paper cut
• Visceral pain


  Pain arising from visceral organs, such as the GI tract and bladder; well or poorly localized: often referred to cutaneous sites
• Pain Assessment - PQRSTU

  • P - proactive or palliation: when did it start? Cause? What makes it better/worse?
  • Q - quality or quantity: what does the pain feel like? (use descriptive words)
  • R - region/radiation: where is the pain located? Does the pain radiate, so where else?
  • Severity scale: Rate pain from 0-10, zero being no pain and 10 being worst pain/severe
  • Timing/treatmen: when did it start, how long, does it often occur, sudden or gradual? Did you take any medications or any treatments to help ease pain?
  • Understanding: let the patient you will let the team know, to advise/prescribe any interventions to help
• Pain Scale

  • 0 NO PAIN
  • 1-3 MILD PAIN
  • 4-6 MODERATE PAIN
  • 7-10 SEVERE PAIN
• Neuropathic pain


  Abnormal processing of sensory input by the peripheral or central nervous system CNS
• Neuropathic pain

  • A person with neuropathic pain might experience burning, shooting, or stabbing sensations, often in areas affected by nerve injury or disease, such as the hands or feet
• Sympathetically maintained pain


  Pain that persists secondary to sympathetic nervous system activity
• Sympathetically maintained pain


  • Phantom limb pain, complex regional pain syndrome
• Nursing Assessment


  • Neurovascular assessment: 6 Ps – monitors for compartment sydrome
  • Pain Assessment: PQRSTU
  • Assessing breathing and ventilation
  • Assessing fluids – intake and output
  • Assessing wound: TIME: TISSUE, INFECTION/INFLAMMATION/MOSITURE/EDGE
• ABCDE


  • AIRWAY: 02 ADMINSTRRATION
  • BREATHING – CHECK FOR HYPOXIA
  • CIRCULATION – MONITOR CLOSELY
  • DRAINS, DRESSINGS, DRIPS
  • EXTRAS – PAIN, VITALS (TEMP ETC.)
• Nursing Interventions


  • Fluid management – intake and output
  • Pain management
  • Encouraging mobilisation
  • Applying TED stocking
  • Education on healing
  • Diet
  • Wound care
  • Deep breathing and coughing
• Interventions for Bone Fracture

  • Consider 6 Ps. Consider unrelenting pain and oedema
  • Pain - Administer medications as prescribed- this would be antibiotics, several different pain relief and anti-emetics, also consider any pre-existing conditions
  • Teach exercises as relevant
  • Medications
  • Regular prescribed pain relief in response to pain assessment if appropriate
  • Encourage exercises if appropriate
  • Encourage mobilisation as appropriate (establish weight bearing status first)
  • Pressure area care (PAC)
  • Cast & wound care and education
  • Regular nutrition & hydration: May need feeding assistance
  • Assist with hygiene if necessary
  • Encourage deep breathing and coughing
  • Elevate extremity if appropriate
• Deep Vein Thrombosis (DVT)

  Blood Clot Formation
• Blood Clot Formation


  1. Patients lie in bed for long periods

  2. Blood flow in the legs slows down

  3. Blood clots in deep veins, usually in the legs
• Inflammation


  The presence of a clot can cause inflammation in the vein, leading to pain and swelling
• Thrombus


  A blood clot that forms in a vein
• Venous Stasis


  Slow blood flow in the veins, often due to immobility
• Pulmonary Embolism (PE)


  Clot Migration
• Clot Migration


  1. A piece of a blood clot from a DVT can break off

  2. Travel to the lungs

  3. Block a blood vessel there
• Impaired Oxygenation


  This blockage can reduce oxygen levels in the blood and strain the heart, leading to chest pain, difficulty breathing, and potentially life-threatening complications
• Embolus


  A blood clot that travels through the bloodstream
• Pulmonary Arteries


  The blood vessels that carry blood from the heart to the lungs
• Haemorrhage/Hypovolaemic Shock


  Blood Loss
• Blood Loss


  1. Excessive bleeding during or after surgery

  2. Leads to a significant loss of blood volume
• Shock


  This loss of blood reduces the amount of oxygen and nutrients delivered to tissues, causing organs to start shutting down
• Hypovolaemia


  A decrease in blood volume
• Shock


  A condition where blood flow is insufficient to meet the body's needs
• Infection


  1. Bacteria, viruses, or other pathogens can infect the lungs after surgery

  2. Especially if breathing is shallow and coughing is suppressed
• Inflammation


  The infection causes inflammation and fluid accumulation in the lung's air sacs, making it hard to breathe and get enough oxygen
• Alveoli


  Tiny air sacs in the lungs where gas exchange occurs
• Infection


  Invasion and multiplication of pathogens in body tissues
• Atelectasis


  Lung Collapse
• Lung Collapse


  1. Part of the lung can collapse when air sacs (alveoli) do not expand fully

  2. Often due to shallow breathing after surgery
• Impaired Oxygenation


  This reduces the area available for oxygen exchange, leading to low oxygen levels in the blood
• Atelectasis


  Collapse of part or (rarely) all of a lung