Class Talk Fall 2016

By Annie Alward, Hanna Persin, and Jane Shon

1. 
2. The nurse’s priority involves frequent assessment of the neurovascular function. This is done by looking at the “five P’s.” these include assessing pain, pallor, pulselessness, paresthesias, and paralysis. Pallor may suggest a decrease in arterial perfusion, pulselessness (a late sign) may suggest lack of distal tissue perfusion, paresthesias suggests nerve involvement, and paralysis, also a late sign, indicates nerve damage.
3. If compartment syndrome occurs in the legs, limitations in movement may occur such as walking. Cramping or aching may develop as the symptoms worsen over time.
4. Discharge would include educating patients on signs and symptoms (if wound is draining/pus/smells abnormal). Instructing patients of things such as if pain or swelling does not go away, if color of injured arm or leg turns blue or white and/or feels cold or numb, and if there is blood soaking through the cast/bandage. If there is a fever, excessive swelling, rash/itch, etc., contact or seek care immediately. Take medicine as prescribed and directed. Elevate arm or leg at the level of heart for as long as doctor recommends, decreases swelling and pain. Do not raise it higher than heart. Elevate with pillows or blankets. Check that brace/bandage fits by checking if 2 fingers can fit between skin/brace/bandage. Never poke or scratch under bandage.

By Annie Alward, Hanna Persin, and Jane Shon

1. 
2. The nurse’s priority involves frequent assessment of the neurovascular function. This is done by looking at the “five P’s.” these include assessing pain, pallor, pulselessness, paresthesias, and paralysis. Pallor may suggest a decrease in arterial perfusion, pulselessness (a late sign) may suggest lack of distal tissue perfusion, paresthesias suggests nerve involvement, and paralysis, also a late sign, indicates nerve damage.
3. If compartment syndrome occurs in the legs, limitations in movement may occur such as walking. Cramping or aching may develop as the symptoms worsen over time.
4. Discharge would include educating patients on signs and symptoms (if wound is draining/pus/smells abnormal). Instructing patients of things such as if pain or swelling does not go away, if color of injured arm or leg turns blue or white and/or feels cold or numb, and if there is blood soaking through the cast/bandage. If there is a fever, excessive swelling, rash/itch, etc., contact or seek care immediately. Take medicine as prescribed and directed. Elevate arm or leg at the level of heart for as long as doctor recommends, decreases swelling and pain. Do not raise it higher than heart. Elevate with pillows or blankets. Check that brace/bandage fits by checking if 2 fingers can fit between skin/brace/bandage. Never poke or scratch under bandage.

By Annie Alward, Hanna Persin, and Jane Shon

1. 
2. The nurse’s priority involves frequent assessment of the neurovascular function. This is done by looking at the “five P’s.” these include assessing pain, pallor, pulselessness, paresthesias, and paralysis. Pallor may suggest a decrease in arterial perfusion, pulselessness (a late sign) may suggest lack of distal tissue perfusion, paresthesias suggests nerve involvement, and paralysis, also a late sign, indicates nerve damage.
3. If compartment syndrome occurs in the legs, limitations in movement may occur such as walking. Cramping or aching may develop as the symptoms worsen over time.
4. Discharge would include educating patients on signs and symptoms (if wound is draining/pus/smells abnormal). Instructing patients of things such as if pain or swelling does not go away, if color of injured arm or leg turns blue or white and/or feels cold or numb, and if there is blood soaking through the cast/bandage. If there is a fever, excessive swelling, rash/itch, etc., contact or seek care immediately. Take medicine as prescribed and directed. Elevate arm or leg at the level of heart for as long as doctor recommends, decreases swelling and pain. Do not raise it higher than heart. Elevate with pillows or blankets. Check that brace/bandage fits by checking if 2 fingers can fit between skin/brace/bandage. Never poke or scratch under bandage.

1. 
2. The nurse’s priority involves frequent assessment of the neurovascular function. This is done by looking at the “five P’s.” these include assessing pain, pallor, pulselessness, paresthesias, and paralysis. Pallor may suggest a decrease in arterial perfusion, pulselessness (a late sign) may suggest lack of distal tissue perfusion, paresthesias suggests nerve involvement, and paralysis, also a late sign, indicates nerve damage.
3. If compartment syndrome occurs in the legs, limitations in movement may occur such as walking. Cramping or aching may develop as the symptoms worsen over time.
4. Discharge would include educating patients on signs and symptoms (if wound is draining/pus/smells abnormal). Instructing patients of things such as if pain or swelling does not go away, if color of injured arm or leg turns blue or white and/or feels cold or numb, and if there is blood soaking through the cast/bandage. If there is a fever, excessive swelling, rash/itch, etc., contact or seek care immediately. Take medicine as prescribed and directed. Elevate arm or leg at the level of heart for as long as doctor recommends, decreases swelling and pain. Do not raise it higher than heart. Elevate with pillows or blankets. Check that brace/bandage fits by checking if 2 fingers can fit between skin/brace/bandage. Never poke or scratch under bandage.

Jessica Dorthalina and Ansley Knipper

• What is ORIF?
  • Surgery to fix a fracture (broken bone) in your hip by putting the broken parts of the femur bone back together using special metal hardware.
• What do you assess? (priority)
  • Airway- postoperative
  • Pulses (pedal), extremity temperature
  • Neurovascular assessment on regular basis
  • Numbness or burning in extremities
  • Pain
  • Vitals
  • Diagnostic tests: CBC, blood chemistry, X-ray studies of the hip and pelvis
  • Assess post-op site for drainage, infection

• Are there any limitations to mobility? 
  • Yes, physical therapy is often needed to improve mobility, decrease pain, improve strength, and to decrease the risk of loss of function.

• What would your D/C teaching include?
  • Prevent falls by wearing fitted shoes, removing furniture or throw rugs in the home that can be a potential fall risk
  • Possible home health nurse referral. Elevated toilet seat, elevated cushions for chair, teach patients to use assistive devices (walker, crutches) safely
  • Continue taking blood thinners and pain medications as needed
  • Pain medication management, self care management, monitoring for potential complications

Jessica Dorthalina and Ansley Knipper

• What is ORIF?
  • Surgery to fix a fracture (broken bone) in your hip by putting the broken parts of the femur bone back together using special metal hardware.
• What do you assess? (priority)
  • Airway- postoperative
  • Pulses (pedal), extremity temperature
  • Neurovascular assessment on regular basis
  • Numbness or burning in extremities
  • Pain
  • Vitals
  • Diagnostic tests: CBC, blood chemistry, X-ray studies of the hip and pelvis
  • Assess post-op site for drainage, infection

• Are there any limitations to mobility? 
  • Yes, physical therapy is often needed to improve mobility, decrease pain, improve strength, and to decrease the risk of loss of function.

• What would your D/C teaching include?
  • Prevent falls by wearing fitted shoes, removing furniture or throw rugs in the home that can be a potential fall risk
  • Possible home health nurse referral. Elevated toilet seat, elevated cushions for chair, teach patients to use assistive devices (walker, crutches) safely
  • Continue taking blood thinners and pain medications as needed
  • Pain medication management, self care management, monitoring for potential complications

Jessica Dorthalina and Ansley Knipper

• What is ORIF?
  • Surgery to fix a fracture (broken bone) in your hip by putting the broken parts of the femur bone back together using special metal hardware.
• What do you assess? (priority)
  • Airway- postoperative
  • Pulses (pedal), extremity temperature
  • Neurovascular assessment on regular basis
  • Numbness or burning in extremities
  • Pain
  • Vitals
  • Diagnostic tests: CBC, blood chemistry, X-ray studies of the hip and pelvis
  • Assess post-op site for drainage, infection

• Are there any limitations to mobility? 
  • Yes, physical therapy is often needed to improve mobility, decrease pain, improve strength, and to decrease the risk of loss of function.

• What would your D/C teaching include?
  • Prevent falls by wearing fitted shoes, removing furniture or throw rugs in the home that can be a potential fall risk
  • Possible home health nurse referral. Elevated toilet seat, elevated cushions for chair, teach patients to use assistive devices (walker, crutches) safely
  • Continue taking blood thinners and pain medications as needed
  • Pain medication management, self care management, monitoring for potential complications

Jessica Dorthalina and Ansley Knipper

• What is ORIF?
  • Surgery to fix a fracture (broken bone) in your hip by putting the broken parts of the femur bone back together using special metal hardware.
• What do you assess? (priority)
  • Airway- postoperative
  • Pulses (pedal), extremity temperature
  • Neurovascular assessment on regular basis
  • Numbness or burning in extremities
  • Pain
  • Vitals
  • Diagnostic tests: CBC, blood chemistry, X-ray studies of the hip and pelvis
  • Assess post-op site for drainage, infection

• Are there any limitations to mobility? 
  • Yes, physical therapy is often needed to improve mobility, decrease pain, improve strength, and to decrease the risk of loss of function.

• What would your D/C teaching include?
  • Prevent falls by wearing fitted shoes, removing furniture or throw rugs in the home that can be a potential fall risk
  • Possible home health nurse referral. Elevated toilet seat, elevated cushions for chair, teach patients to use assistive devices (walker, crutches) safely
  • Continue taking blood thinners and pain medications as needed
  • Pain medication management, self care management, monitoring for potential complications

Jessica Dorthalina and Ansley Knipper

• What is ORIF?
  • Surgery to fix a fracture (broken bone) in your hip by putting the broken parts of the femur bone back together using special metal hardware.
• What do you assess? (priority)
  • Airway- postoperative
  • Pulses (pedal), extremity temperature
  • Neurovascular assessment on regular basis
  • Numbness or burning in extremities
  • Pain
  • Vitals
  • Diagnostic tests: CBC, blood chemistry, X-ray studies of the hip and pelvis
  • Assess post-op site for drainage, infection

• Are there any limitations to mobility? 
  • Yes, physical therapy is often needed to improve mobility, decrease pain, improve strength, and to decrease the risk of loss of function.

• What would your D/C teaching include?
  • Prevent falls by wearing fitted shoes, removing furniture or throw rugs in the home that can be a potential fall risk
  • Possible home health nurse referral. Elevated toilet seat, elevated cushions for chair, teach patients to use assistive devices (walker, crutches) safely
  • Continue taking blood thinners and pain medications as needed
  • Pain medication management, self care management, monitoring for potential complications

1. What do you asses (priority)

-Pain, Pt’s general health, pervious and current injuries, Observe posture: standing/walking, arch of foot, look for fallen arches, high arch, overpronation/over supination. Palpation: inside of heel and arch, pain indicates plantar fasciitis. Range of motion: checking amount of dorsiflexion, decreased range can indicate tight calf muscles.

2. The pain from plantar fasciitis could limit the patient’s ability to walk, especially if it is left untreated and bone spurs develop on the heel.

3. Discharge teachingwould include stretching techniques that help relieve the pain, and use of orthotic devices and supportive shoes.