Professional Documents
Culture Documents
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Perioperative
Review on
OPEN
REDUCTION
INTERNAL
FIXATION
Submitted to:
Llywelyn I. Cortez Rn.
Submitted by:
Jay Ian C. Reterba
Bsn3
13D
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Table of Contents
I.Introduction ...3
II.Definition of terms4
III.Anatomy and pyshiology ...5
IV.Surgical procedure ...............7
V.Instruments9
VI. Perioperative Tasks and Responsibilities of the nurse ..18
VII.NCP.21
VIII.DRUGS.....24
IX.Reference/Bibliography..27c
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A fracture is the (local) separation of an object or material into two, or more, pieces
under the action of stress.
The word is often applied to bones of living creatures, or to crystals or crystalline
materials, such as gemstones or metal. Sometimes, in crystalline materials, individual crystals
fracture without the body actually separating into two or more pieces. Depending on the
substance which is fractured, a fracture reduces strength (most substances) or inhibits
transmission of light (optical crystals).
Fracture is any break in the continuity of bone. In some cases, a bone may fracture
without visibly breaking. Fractures occur when the bone is subjected to stress greater than it
can absorb. It can be caused by a direct blow, crushing force, sudden twisting motion, or even
extreme muscle contraction. When the bone is broken, adjacent structures are also affected,
resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations,
ruptured tendons, severed nerves, and damaged blood vessels. Body organs may be injured by
the force that caused the fracture or by the fracture fragments. And according to the physician
the kind of fracture that my PT experience is comminuted fracture that the bone splinters at the
site of impact, and smaller bone fragments lie between the two main fragments. c
Femur is the largest and strongest bone and has a good blood supply. Because of this and its
protective surrounding muscle, the shaft requires a large amount of force to fracture. Once a
fracture does occur, this same protective musculature usually is the cause of displacement,
which commonly occurs with femoral shaft fractures. Orthopedic surgeons often encounter
femur fractures because these fractures most often result from high-energy trauma, one must
have a high index of suspension for complications or other injuries like vehicular accident that
experience by my PT While a variety of treatment options exist for a fracture that is associated
to injury.
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Biceps- a biceps muscle, esp. the one at the front of the upper arm.
Cartilage- a firm, elastic, flexible type of connective tissue of a translucent whitish or yellowish
color; gristle.
Femur - the largest and strongest bone and has a good blood supply
Fracture - (local) separation of an object or material into two, or more, pieces under the action of
stress.
In human anatomy, the femur is the longest and largest bone. Along with the temporal
bone of the skull, it is one of the two strongest bones in the body. The average adult male femur
is 48 centimeters (18.9 in) in length and 2.34 cm (0.92 in) in diameter and can support up to 30
times the weight of an adult.[1] It forms part of the hip joint (at the acetabulum) and part of the
knee joint, which is located above. There are four eminences, or protuberances, in the human
femur: the head, the greater trochanter, the lesser trochanter, and the lower extremity. They
appear at various times from just before birth to about age 14. Initially, they are joined to the
main body of the femur with cartilage, which gradually becomes ossified until the protuberances
become an integral part of the femur bone, usually in early adulthood.
The shaft of femur is cylindrical with a rough line on its posterior surface (linea aspera).
The intercondylar fossa is present between the condyles at the distal end of the femur. In
addition to the intercondylar eminence on the tibial plateau, there is both an anterior and
posterior intercondylar fossa (area), the sites of anterior cruciate and posterior cruciate ligament
attachment, respectively.
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Physical trauma
due to vehicular
accident
Break in the
skin
Tissue
damage
Bone cannot
withstand the ouside
body forces
nerve endings that
surrounds bone contain caused
pain fibers Breakage of
bone
these fibers become
irritated when bone is
broken or bruised
series of bleeding
internally and externally
blood is associated to
swelling (edema)
Resulting to Immobilization
of the injured lower
extremity
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A " retractor (manual) is used to retract deep abdominal or chest incisions. Available in various
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are used to grasp delicate
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Pre-operative Responsibilities
1. Assist with the preparation of the room for the designated surgical procedure, including
gathering supplies for the procedure.
2. Scrub, dry hands, gown, and glove.
3. Assist person scrubbed in first position with:
a. Setting up back table, mayo, and basins
b. Arrangement of instruments
c. Preparation of suture and needles
d. Preparation and counting sponges
e. Arrangement and preparation of other necessary items
f. Gowning and gloving surgeon and assistants
g. Assist with draping
h. Arrangement of sterile field
Intra-operative Responsibilities
1. During the procedure, progress from double-scrubbed position. Train self to keep eyes on
field, and learn steps of procedure.
2. Begin developing methods of anticipating needs of surgeon and assistant.
3. After closing the skin:
a. Assist with care of instruments and counts if necessary
b. Care of specimen
c. Assist with dressing of wound
Post-operative Responsibilities
1. After the completion of the Procedure:
a. Assist with the gathering of all materials used during the procedure
b. Discard items as necessary being careful to discard sharp items in designated places
c. Return all items to respective area
d. Assist with cleaning of room
e. Clean the materials used properly and arrange them after drying
2. Perform any duties which will speed up the surgical procedure to follow in that room.
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Pre-operative Responsibilities
1. Care for the patient before surgery by:
a. Greeting patient and assist nurse with identification
b. Checking patient's chart, preparation, etc.
2. Prepare the room by:
a. Obtaining instruments, supplies, and equipment for the designated operative procedure
b. Opening unsterile supplies
c. Assisting in gowning
d. Observing breaks in sterile technique
e. Assisting anesthesiologist as necesssary
f. Assisting with skin preparation and positioning
g. Assisting with forming of the sterile field
3. Count the instruments, sharps and sponges before the procedure and confirm with scrub
nurse.
Intra-operative Responsibilities
1. During the Procedure:
a. Remain in room and dispense materials as necessary
b. Observe procedure as closely as possible
c. Begin establishing method of anticipating needs of surgical team
d. Care of specimen as indicated
e. Care of operative records as indicated
2. Before the closing of the organ or peritoneum, count all instruments, sharps and sponges and
confirm with scrub nurse.
3. Inform the surgeon and assistant surgeon of a report of the instruments.
Post-operative Responsibilities
1. Properly document all the necessary information on the patients chart.
2. Assist in the cleaning of the Operation Room as necessary.
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A careful history and physical examination are performed to exclude the possibility of
other gastrointestinal diseases that may mimic biliary colic, such as peptic ulcer disease
or reflux esophagitis.
When the diagnosis of acute cholecystitis is suspected the patient should receive
nothing by mouth; however, nasogastric suction usually can be reserved for patients
who are vomiting or have ileus and abdominal distention.
Intravenous fluids are given to correct volume depletion and any electrolyte imbalances
are measured and corrected. Monitor and regulate IVFs
The nurse instructs the patient about the need to avoid smoking to enhance pulmonary
recovery postoperatively and avoid respiratory complications. It is also important to
instruct the patient to avoid the use of aspirin and other agents that can alter coagulation
and other biochemical process
On of the most important responsibility of the nurse is to let the patient sign an informed
consent regarding the surgery.
The patient is given anaesthesia prior to surgery and the patient is under NPO.
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Monitoring the vital signs of the patient is one of the responsibilities of the nurse during
the surgery.
Assisting the anesthesia care provider during induction of general anesthesia
Ensuring adequate oxygenation and hydration
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After recovery, the nurse places the patient in the low fowlers position. IV fluids may be
given and nasogastric suction may be given to relieve abdominal distention. Water and
other fluids are given in about 24hours, and soft diet is started when bowel sounds
returned.
Placing warm blankets on the patient to enhance comfort and preserve the patient's
body temperature
Assessing the patient's vital signs, oxygen saturation level, level of consciousness,
circulation, pain, IV site, fluid rate, and hydration status, as well as the status of the
surgical site and dressing and all related monitoring equipment
The nurse helps in relieving the pain by instructing the patient regarding proper
positioning.
The nurse helps in improving the respiratory status by instructing the patient regarding
deep breathing exercises.
The nurse also provides skin care like cleaning the incision part and providing clean
dressing following a strict aseptic technique
The nurse instructs the patient about the medications that are prescribed by the
physician
Discussing recommended follow-up management with the physician and the surgeon
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ASSESSMENT SCIENTIFIC PLANNING INTERVENTION RATIONALE EXPECTED
EXPLANATION OUTCOME
S
S>Masakit yung Unpleasant sensory and > Within one Independent: >After one
inopera sa akin, as emotional experience hour of > Offer divertional activities > Heighten ones hour of
verbalized by the arising from actual or appropriate such as reading concentration upon appropriate
patient. potential tissue damage or nursing newspaper or magazines, nonpainful stimuli to nursing
> pain scale of described in terms of such intervention, socialization with others or decrease ones intervention,
7/10 damage; sudden or slow the patients listening radio. awareness and the patients
O >weak in onset of any intensity from pain scale will experience of pain. pain scale
appearance mild to severe with an alleviate from > Monitor vital signs: will alleviate
>guarding anticipated or predictable 7/10 to 3/10. (RR and BP) from 7/10 to
behavior/self- end and duration of less > vital signs usually 3/10 as
protective behavior than 6 months. altered in acute pain evidenced
>limited movement > Instruct deep breathing by:
>grimace upon exercises. a. can
movement move
> to improve
> irritable and freely
pulmonary gas
restless b. verba
exchange or to
maintain respiratory lized
Nursing Diagnosis: function incre
> Provide comfort
Acute pain and ase
measures such as backrub
discomfort related to level
and changing position
surgical incision. of
every 2 hours. > to provide
comf
nonpharmacological
ort
> Provide quiet pain management and
environment and calm to prevent pressure
activities. ulcer
Generic Brand Mech. Action Classification Indication Contraindication Adverse Dosage Nursing Rep.
name Name effect
Atracuriu Tracriu Drugs which may Musculoskele as an adjunct to hypersensitivity to Wheezing 0.4 to
m m enhance the tal agents general anesthesia, to it Hypotension 0.5
Besylate neuromuscular Neuromuscul facilitate endotracheal Use of atracurium Skin Flush mg/kg
blocking action of ar blockers intubation and to besylate from anaphylactic
atracurium nondepolarizi provide skeletal multiple-dose vials or
besylate include: ngRelaxants muscle relaxation containing benzyl anaphylactoi
enflurane; during surgery or alcohol as a d responses
isoflurane; mechanical preservative is
halothane; ventilation. contraindicated in
certain patients with a
antibiotics, known
especially the hypersensitivity to
aminoglycosides benzyl alcohol
and polymyxins;
lithium;
magnesium salts;
procainamide;
and quinidine.
If other muscle
relaxants are
used during the
same procedure,
the possibility of
a synergistic or
antagonist effect
should be
considered
Generic Brand Mech. Action Classification Indication Contraindication Adverse Dosage Nursing Rep.
name Name effect
TRANEXA antifibrinolytic Haemostatics This medication is Severe renal Nausea, 1-1.5 g
MIC ACID Cykloka agent that used for short-term failure, active vomiting,
pron competitively control of bleeding in intravascular diarrhea
inhibits hemophiliacs, clotting, vision
breakdown of including dental thromboembolic changes,
fibrin clots. It extraction procedures. disease, colour dizziness
blocks binding of used for many other vision disorders,
plasminogen and conditions in which subarachnoid
plasmin to fibrin, bleeding control is bleeding.
thereby required such as after
preventing surgery or injury,
haemostatic plug recurrent nosebleeds
dissolution. or abnormal vaginal
bleeding.
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http://66.218.69.11/search/cache?ei=UTF-
8&p=medications+for+post+cholecystectomy&fr=yfp-t-501-
s&u=www.facs.org/public_info/operation/cholesys.pdf&w=medications+medicated+medicati
on+post+cholecystectomy&d=UzolavL9P0uZ&icp=1&.intl=us
http://dcregistry.com/users/cholecystectomy/preoperative.htmlv
http://www.emedmag.com/html/pre/fea/features/021503.asp
http://www.encyclopedia.com/doc/1G1-103379524.html
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/he
althatoz/Atoz/ency/cholecystectomy.jsp
http://www.facebook.com/blackwinter.o14#!/sometwo.hangal?ref=profile
http://www.medscape.com/viewarticle/535569?rss
http://www.scribd.com/doc/11972130/Open-Cholecystectomy-surgical-case-report
http://nursingcrib.com/nursing-notes-reviewer/cleft-lip-and-palate/