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    3 Askep Klien DG Orif-Oref

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    Intansari Rahmawati
    This document discusses nursing care for patients who have undergone open reduction internal fixation (ORIF) or open reduction external fixation (OREF) procedures for fractures or other orthopedic injuries. It provides details on the procedures, indications for use, post-operative nursing care including wound monitoring, infection prevention, range of motion exercises, and rehabilitation. The goal of ORIF and OREF is to restore anatomical alignment and bone stability to allow for early mobilization and recovery of function. Key nursing responsibilities involve assessing for complications and teaching patients how to care for devices and promote healing.

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    3 Askep Klien DG Orif-Oref

    Uploaded by

    Intansari Rahmawati
    27 views45 pages
    This document discusses nursing care for patients who have undergone open reduction internal fixation (ORIF) or open reduction external fixation (OREF) procedures for fractures or other orthopedic injuries. It provides details on the procedures, indications for use, post-operative nursing care including wound monitoring, infection prevention, range of motion exercises, and rehabilitation. The goal of ORIF and OREF is to restore anatomical alignment and bone stability to allow for early mobilization and recovery of function. Key nursing responsibilities involve assessing for complications and teaching patients how to care for devices and promote healing.

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    3 ASKEP KLIEN DG ORIF-OREF

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    This document discusses nursing care for patients who have undergone open reduction internal fixation (ORIF) or open reduction external fixation (OREF) procedures for fractures or other orthopedic injuries. It provides details on the procedures, indications for use, post-operative nursing care including wound monitoring, infection prevention, range of motion exercises, and rehabilitation. The goal of ORIF and OREF is to restore anatomical alignment and bone stability to allow for early mobilization and recovery of function. Key nursing responsibilities involve assessing for complications and teaching patients how to care for devices and promote healing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views45 pages

    3 Askep Klien DG Orif-Oref

    Uploaded by

    Intansari Rahmawati
    This document discusses nursing care for patients who have undergone open reduction internal fixation (ORIF) or open reduction external fixation (OREF) procedures for fractures or other orthopedic injuries. It provides details on the procedures, indications for use, post-operative nursing care including wound monitoring, infection prevention, range of motion exercises, and rehabilitation. The goal of ORIF and OREF is to restore anatomical alignment and bone stability to allow for early mobilization and recovery of function. Key nursing responsibilities involve assessing for complications and teaching patients how to care for devices and promote healing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 45

    Nursing care for clients with

    ORIF and OREF actions


    by.Sunarto .,S.ST., Ners.,MKes

    Polytechnic Health Nursing Programs


    Ministry of Health Republic of Indonesia
    Surakarta 2020
    What can we do to prevent
    mishandling
    Fractures
    Dislocation
    Degenerative joint disease
    Osteoporosis
    Herniated disc
    Amputation
    Treatment immediately
    Fraktur terbuka
    Sindrom kompartemen
    Dislokasi
    Cedera neurovaskular
    Arthritis septik
    Cedera tulang belakang dengan
    penurunan status neurologis
    Treatment Fractures
    Reduction/Realignment
    Immobilization
    Nursing care
    Prevention and early detection:
    complication
    Reduction/Realignment
    Correct bone alignment goal: restore
    injured part to normal or near-normal
    function
    Closed vs. open reduction
    Open reduction = surgery
    Immobilization
    to maintain alignment
    Casts
    External fixation (OREF)
    Internal fixation (ORIF)
    Traction
    CASTS
    Casts
    External, circumferential
    Thermochemical reaction = warmth
    Nursing care:
    No weight bearing 24-72 hours
    “flat hands”
    Elevate
    Neuro-vascular checks
    CASTS
    Cast: Client/Family Teaching
    Keep dry
    No foreign objects in cast
    No weight bearing until order (at least
    48 hour)
    Elevate above heart (48 hours)
    Signs of problems to report
    Pain, tingling, burning
    Sores, odor
    OPEN REDUCTION EXTERNAL FIXATION

    Metal pins inserted into bone


    Pins attach to external rods
    Nursing care:
    Assess for s/s infection
    Teach pin care: ½ H2O2+ ½ H2o
    Open reduction: assess incision
    Elevate
    Neurovascular checks
    OPEN REDUCTION EXTERNAL FIXATION
    PRIMARY INDICATION
    • POLY TRAUMA PATIENT.
    • CLOSED FX. WITH SEVERE
    SOFT TISSUE INJURY.
    • PELVIC RING DISRUPTIONS.
    • CHILDREN’S FRACTURE.
    • OPEN FRACTURE .
    Polytrauma
    Temporary stabilization of long bone
    injuries in unstable patient
    – Minimally invasive
    – Decreases bleeding
    – Pain control
    – Nursing care
    – “Damage control”
    Closed Fractures with Soft
    Tissue Compromise
    Swelling
    Fracture blisters
    Closed Fractures with Soft
    Tissue Compromise

    Crush injuries
    Burns
    Closed Fractures with Soft
    Tissue Compromise
    Compartment syndrome
    Open Fractures
    • Avoids injury site
    • Avoids additional injury
    to soft tissues and
    vascularity
    Pelvic Fractures
    Temporary stabilization for
    closed fractures
    Controls hemorrhage
    Decreases clot shear
    Pelvic Fractures
    Open pelvic fractures = “The lethal injury”
    Pelvic Fractures
    Quick application
    Open or percutaneous pin
    insertion
    Easily removed for
    definitive ORIF
    Children’s Fractures
    Femoral fractures
    One alternative to weeks of
    skeletal traction
    Used less with use of flexible
    nails
    Children’s Fractures
    Pin placement must avoid
    growth plate
    Watch for pin tract infection
    Occasional joint stiffness
    Open Fractures
    Open Fractures
    Segmental bone loss
    Open Fractures

    Fractures needing nerve or


    vessel repair
    SECONDARY INDICATION
    • DELAY OPEN FRACTURE.
    • INFECTED NON-UNION.
    • LIMB LENGTHENING.
    • BONE TRANSPORTATION.
    • ARTHRODESIS.
    OPEN REDUCTION INTERNAL FIXATION

    Pins, plates, screws surgically inserted


    Nursing care:
    Assess incision site
    Orders: activity, weight bearing, ROM,
    Assess s/s infection; temp. q 2-4 hours
    Neurovascular checks
    OPEN REDUCTION INTERNAL FIXATION
    1.Fracture reduction and fixation to restore
    anatomical relationship, allowing functional
    aftercare.
    2.Adequate stability by interfragmentary
    compression or splintage as the personality of
    the fracture and the injury require.
    3. Preservation of the blood supply to soft
    tissue and bone by careful handling and
    gentle reduction technique.
    4. Early and safe mobilization of the injured
    part and the patient as a whole
    Fracture has been defined as:
    “Soft Tissue Injury with a
    Broken Bone”
    Blood Supply of the bone
    comes from Soft Tissues
    Restore optimum function to the limb or body
    part

    Advantage of Internal Fixation: Superior


    Results, Rehabilitation goes on at same time
    as Healing of Fracture

    Disadvantage: Technically demanding, Risk of


    Infection and Fixation Failure
    Intra-articular and Certain Shaft Fractures
    (Shaft Fractures of Radius/Ulna) – Reduction
    must be Anatomical
    Only way to achieve this is by Open Reduction
    Shaft Fractures – Obtain Length, Rotation &
    Alignment
    Technique: Indirect or Direct Reduction
    Surgery adds to the Trauma to the Fracture
    Gentle Soft Tissue Handling (Biological Fixation)
    Fixation techniques – Plates, Nails, Screws, Wires
    or any combination
    Timing of Surgery
    Surgical Approach & Pre-operative Planning
    Early Safe Mobilization of Injured Limb &
    Patient
    Joints – Nutrition, prevention of stiffness,
    arthrofibrosis
    Muscles – Prevent atrophy, maintain excursion,
    strength
    Absolute Stability – Intraarticular Fractures
    Interfragmentary Screws
    Relative Stability – Shaft Fractures
    Interlocking Intramedullary Nails, Plates used as
    Internal Splints
    1. Reduce Fracture
    • Joints: Anatomically;
    • Shaft – Length, Alignment Rotation
    2. Fix Fracture Safely
    • Minimal Soft Tissue Damage “Biological
    Fixation”
    • Timing
    • Pre-operative Planning & Approach
    3. Stable Fixation to allow Early Safe
    Motion & Rehabilitation
    Asuhan Keperawatan

    PENGKAJIAN
    DIAGNOSA KEPERAWATAN
    INTERVENSI KEPERAWATAN
    IMPLEMENTASI KEPERAWATAN
    EVALUASI KEPERAWATAN
    BANYAK BELAJAR, BANYAK LUPA

    SEDIKIT BELAJAR, SEDIKIT YANG LUPA

    TIDAK PERNAH BELAJAR, TIDAK ADA YANG


    DILUPAKAN
    KARENA TIDAK TAHU APA-APA

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