Lesson #2
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Identify the principles of rehabilitation after a fracture
Describe arthroplasty and teaching for the patient in
rehabilitation after a joint replacement
Describe the role of the rehab nurse in fracture and
arthroplasty rehabilitation
Describe amputation rehabilitation
State the interventions by the rehab nurse that can help
the patient with arthritis to improve functional abilities
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Over 10 million people in USA have
osteoporosis
1.5 million fractures are credited to
osteoporosis
350, 000 hip fractures included
More than 70% of knee/hip replacements from
osteoarthritis
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Bone infection
Severe osteoporosis
Uncontrolled medical problem
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Normal position healing
Full ROM to joints around fracture
Normal strength returns
Prevent complications
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A fracture will require immobilization of the
joint both above and below the fracture site
during the healing process
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Muscle/Skeletal Rehab Nursing
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Require very little treatment
Rehab course begins as soon as initial
symptoms of fracture subside.
Perform progressive ROM exercises 3-4 days
post fracture
Progressive strengthening of fracture 3rd of 4th
week post fracture
Example:
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Radial Head Fracture
Non displaced ulna fracture
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Requires some form of immobilization yet
allows movement of the joints nearest fracture
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Can’t be immobilized
Requires surgical intervention
Requires plaster or fiberglass cast
May require a cast or air brace
Examples:
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Hip Fractures
Femur Fractures
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DISADVANTAGES
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Early mobilization
Early return to general
mobility
Sometimes early
protected weight
bearing
Decreased risk with
spinal anesthesia
Newer smaller incisions
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Increased risks w/general
anesthesia (elderly)
Increased risk of infection
Risk of interference w/the
natural physiology of
healing process..(screws
may loosen, unresolved
pain)
ADVANTAGES
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External Fixator
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Used for complicated, very commuted and
grossly unstable fractures
Usually have a lot of soft tissue damage and
edema
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#1 All Joints not requiring immobilization should
be mobilized
#2 Gait Training/weight bearing as soon as
possible
#3 Mobilization of the fracture area as soon as
stability has been achieved
#4 Use of Local Help Techniques for pain and muscle
spasms
#5 Muscle Strengthening as soon as fracture
stabilized
#6 Perform ROM Exercises
#7 Strengthening Exercises
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Atelectasis and Pneumonia
Infection
GU stasis
Deep Vein Thrombosis
Fat Emboli
Pulmonary Emboli
Systemic problems of Immobility
ARDS
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Non-Union
Mal-Union
Infection-Osteomyelitis
Stiffness
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Arthroplasty
Defined
Two Goals
Candidates for surgery
Our focus:
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Hip
Knee
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Causes
S&S of dislocation
Five “P’s” neurovascular check
Nursing responsibility
Anterior
Posterior
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Purpose
When?
Critical pathway
Other replacements
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Routine cast care
Monitor the extremity regularly
Provide/teach skin care/pin site care
Position properly
Supervise and monitor client’s weight bearing
Perform ROM as PT directed
Provide and encourage ADL training
Monitor for systemic and local complications
Monitor and perform pain management
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Children do well for injuries requiring rehab
Indications for an amputation is when the limb
is no longer of any use
Severe trauma
 Thermal injuries
 Infections
 Tumors
 Pain
 Severe circulatory problems)
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Goal with amputations
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Severity of soft tissue damage
Assessment
Vascularity of the tissue
Best level of function
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Care and inspection
S&S of infection
W/C support
Expected outcomes
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Purpose
Dressings
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#1 Prevent hip flexion and external rotation of
stump
#2 Promote prone position
#3 Encourage crutch walking ASAP
#4 Avoid prolong sitting in W/C, bed, chair
#5 Patient performs resistance strengthening
exercises on other limb
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Skin problems
Atrophy
Phantom Limb Sensation
Phantom Pain
Interventions
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Desensitizing techniques
Alternative methods to help phantom pain
Edema
Bony overgrowths
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Appropriate care to enable the patient to wear
a prosthetic
Ensure appropriate care of stump
healing/shrinking
Prevention of contractures
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Rheumatoid Arthritis
Osteoarthritis
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RHEUMATOID
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Chronic/ ?autoimmune
Systemic and
symmetrical
Periods of
exacerbation/remission
Onset: insidious
S&S
Treatment:
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Drugs, rest, Protect,
change environment
OSTEOARTHRITIS
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Degenerative
Unknown cause
Localized and
asymmetrical
Can’t function with
ADLs RT pain
S&S
Treatment: Wt loss
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Drugs, rest, ROM, heat,
Environment changes
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Minimize morning stiffness
Manage environment
Provide /maintain stress free environment
Encourage/support:
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proper positioning
comfort measures
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So what did I learn?
Name one thing
How you will incorporate it into your nursing
practice
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http://www.sportmedstore.com/products/images/POST-OP_WOUND_CARE_FRACTURE.jpg
http://www.mdguidelines.com/images/Illustrations/fr_fem_n.jpg
http://nemsi.uchc.edu/images/image_wristfract1.jpg
http://media.summitmedicalgroup.com/media/db/relayhealth-images/radihead.jpg
http://www.drfoot.co.uk/pictures/CollesFracture.gif
http://www.hmc.org.qa/mejem/sept2003/images/Figure%202%20pg%2044.jpg
http://www.ossur.co.uk/library/10461&proc=6/Soft%20Humeral%20Fracture%20Brace.jpg
http://www.orthosupersite.com/images/content/ot/201012/ot1210podeszwaF1.gif
http://www.irishvetjournal.org/content/figures/2046-0481-62-10-663-3.gif
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/10202.jpg
http://teamofmonkeys.com/html/images/a%20Ilizarov%20External%20Fixation%20at%20Bat%20Yam%20Migdal%20Zahav%20Israel%20
2006%20yfrimer.jpg
http://www.the-hospitalist.org/SpringboardWebApp/userfiles/hosp/image/TH_2012_09_pp09_02.jpg
http://www.doctortipster.com/4163-deep-venous-thrombosis-treatment-and-prophylaxis.html/lovenox
http://hanyhefny.com/images/malunion.jpg
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