Profession experiences

Transcription

1 WACHARIN SRISUK Bangkok Hospital Udon,HOD Education :2000 Bachelor of Nursing science, Thai Red Cross College of Nursing Profession experiences Orthopaedic OR Nurse at King Chulalongkorn Memorial Hospital : 2002 Participant in AO course for ORP Thailand : 2010 AOTrauma Graubünden Chur,Switzerland : 2011,2012 Lecturer & PD for IM nail & DHS in AO course for ORP : 2013 Co-Chairperson for the 50 th AO course for ORP Thailand : 2014 Regional faculty,the 1 st AOTrauma Course for ORP,Myanmar : 2014 Chairperson for the 52 nd AO Course for ORP Thailand : 2015 Regional Faculty AOTrauma Course for ORP,Singapore : 2016 Chairperson for the 54 th AO Course for ORP Thailand(BDMS)

2 Patient Positioning in orthopedics Wacharin Srisuk Bangkok Udon Hospital Basic AO course for ORP,Thailand :22 24 July 2016

3 Course Objectives 1) Identify dangers of patient during transfer. 2)Identify dangers of improper positioning. 3)State techniques for preventing injury to surgical patients.

4 Positioning Injury Intergumentary Pressure ulcer Musculoskeletal system Pain>>Compartment syndrome Over stretching Nervous system Neurapraxia Circulation system Respiratory system Thrombophlebitis,DVT Hypoventilation

5 Provide Optimal acess for Surgeon: -Optimal procedural exposure -Successful operation Anesthesiologist: -Physiologic requirements (A-B-C s) Patient: -Safety -Maintain body alignment -Comfortable -Body exposure should be minimize

6 Key concept for nurse acting as patient advocate. -Knowledge of anatomy and physiology -Knowledge of using correct positioning devices Provide optimal coordination with all team member

7 Preoperative phase 1.Planning the patient s position. - Knowledge 2.Patient assessment.

8 Preoperative Assessment Age/Height/Weight/Body mass index (BMI) Nutritional status Blood pressure Skin integrity ROM/Physical limitations Internal/External devices Preexisting conditions Medical history/diagnostic studies Psychological/Cultural considerations

9 Safety transferring Move slowly and gentle Any body part should not be extened beyond

10 Safety transferring Adequate assistance in lifting unconcious anestized, obese Anesthesia provider giving signal before count 1 2 3

11 Safety transferring **Physician responsibility for protecting an unsplint Fx

12 Safety transferring - Operating bed or transport must be Breaked

13 The transfer of patient Damage to the cervical spine with unsupport head Damage to the limbs Patient falls Skin damage Damage from accidental Traction to infusion line, drainage or catheterization

14 Intraoperative phase Documentation Ongoing assessment

15 Surgical Positions Four basic Supine Prone Lateral Lithotomy Sitting/Beach chair Variations include: Trendelenburg Reverse trendelenburg Fowler s Jackknife High lithotomy Low lithotomy

16 Surgical Positions Supine Prone Lateral Lithotomy Sitting/Beach chair

17 Supine Position

18 Devices -Pillow/Gel -Armboards -Safety strap

19 Nerve injury

20 Nerve injury

21 Bracheal plexus injury Armboards extended beyond 90 Armboards higher or lower than OR bed Lateral rotation of patient s head Leaning against shoulder or arm Shoulder braces

22 ARMS

23 2 above knee level with 3 fingers breath It is one of the most frequently damaged by being compressed against stirrup bar/knee strap and can cause foot drop, loss of dorsal extension of the toes, inability to evert the foot and loss of sensation below the knee

24 Pressure points In Cervical Traction must awareness Alignment Traction Position Airway after drape

25 Anatomic Locations of Pressure Ulcers Incidents for ORAPU - between 8.5% and 66% 1. Sacrum 36.9% 2. Heel 30.3% 3. Ischium (sit bone) 8.0% 4. Elbow 6.9% 5. Malleolus (ankle bone) 6.1% 6. Trochanter (hip bone) 5.1% 7. Knee 3.0% 8. Scapula (shoulder blade) 2.4% 9. Occiput (back of head) 1.3% Occiput Elbow Trochanter Ischium Malleolus Scapula Sacrum Knee Heel Amlung SR, Miller WL, Bosley LM, Adv Skin Wound Care Nov/Dec;14(6): % Heels

26 Prone position

27 Prone position Spinal frame Pillows/Gels Armboards Safety strap

28 - lung capacity/respiratory function

29 Pressure points Eyes 1. Ears 2. Eyes 3. Checks 4. Acromion process 5. Breasts 6. Anterior iliac spine 7. Male genitalia 8. Patellar 9. Toes

30 *Arm broad level not higher than or bed Nerve injury -Brachial plexus -Ulnar nerve -Femoral nerve

31 Keep in mind Females with Large Breasts should be placed Laterally Male genitalia should hang Freely Provide adequate padding under knees Support the ankles Maintain feet in dorsi-flexion

32 Lateral Position

33 Lateral Position Bean bag/hip support Armboards Arm rest/upper arm support Chest roll/gel Safety strap and Pillows

34

35 Lateral Position

36 Pressure points 1. Ear 2. Acromion process 3. Olecranon 4. Ribs 5. Illiac crest 6. Greater trochanter 7. Lateral condyles 8. Lateral malleolus

37 Sitting/Beach chair position

38 -Headrest -Lateral arm support -Pillow -Knee strap -Foot board

39 Pressure ulcer Nerve injury -Ulnar nerve -Common peroneal - Air embolism - Postural hypotension

40 Lithotomy

41 -Pillow -Armboard/Upper armboard -Stirrup -Elastic bandage -Counter traction post -Telescopic bar -Rotation and Traction stirrup -Cotton rolls

42 Pressure ulcer Nerve injury -Brachial plexus -Ulnar nerve -Obturator nerve -Femoral nerve -Common peroneal -Pudendal nerve - Hip dislocation /Fracture

43 Postoperative Phase - Evaluation the patient s condition - Skin condition - Documentation

44 Sign and Symptom of Nerve injury BPI >> Numbness, Abnormal sensation, Weakness Ulnar nerve(cubital tunnel syndrome)>> Numbness, Weakness Obturator nerve>>thigh or groin pain,weakness,medial thigh sensory loss Femoral nerve>> Weakness of knee and leg,numbness Common peroneal>> Footdrop,Pain,Weakness,Numbness Pudendal nerve>>constipation,urinary hesitancy,sexual dysfunction

45 Good Practice/Refference

46 Good Practice/Refference

47 Conclusion Required for safety position Good Planning Good Communication Teamwork Individual care(age, Physical condition,implant) Correct manual/ebp

48 Thank you for your attention