PABLO ARTURO SUAREZ HOSPITAL

ORTHOPEDIC AND TRAUMATOLOGY SERVICE

Q. Ministry
of Public Health

B.TUTORS
NURSING CARE IN PATIENTS WITH

LCDA. LORENA CEVALLOS

21/06/2019
GOALS

> Assess the need for nursing care in relation to the

patient's physical and functional recovery, as well as the
side effects derived from the long period of immobilization
during hospitalization.
> Provide comfort, convenience, security and tranquility to
patients with guardians.
> Avoid the appearance of possible complications
> Reduce the risk of contamination and proliferation of
microorganisms at the insertion site.
 INTRODUCTION
• The external fixator is a metal instrument used in orthopedic
surgery to fix the bone and prevent the risk of fracture . It is
made up of two metal bars and various rods that penetrate
the skin to fix on the bone.
TYPE OF
TUTORS
CLASSIFICATION
• There are several ways to classify fixatives, it is
differentiated by the rigidity and stability of
the
configuration, this Dadaist not only by
he
own design of the device but also by the number and
diameter of the nails used, as well as the distance
between the body of the fixator
and the
bone.
 FIXATORS ARE CLASSIFIED INTO TWO BIG
GROUPS :
TRANSFIXING OR BILATERAL.
NON-TRANSFIXING OR MONOLATERAL
TRANSFIXING FIXATIVES
We understand as Tranfixiantes those fixators that use elements for
fixation that completely go beyond the
bone and muscle groups.
Transfixing systems
The pins, screws or needles of the system must

completely pass through the limb to achieve

stabilization of the bone fragments.

They can be: bilateral, quadrilateral, biplanar and

circular (complete or incomplete).

NON-TRANSFIXING FIXATIVES

• They are those whose elements that connect to the bone

are anchored in the cortex opposite to the one to which it
has been introduced without emerging through the
adjacent muscle group and the skin that covers it.
CIRCULATING
FASTENERS
• In this type of fixators, they join the bone using threaded
longitudinal bars; they are wires that do not exceed 2 mm
and are generally 1.5 mm.
FIXERS
BIPLANAR FIXERS
This is classified by its fixation since it places an axis with a
difference of more than 90° between them.
UNIPLANAR FIXATORS
It is a simple configuration, but not very stable to counteract
forces in the frontal plane, although in general less stable in
all planes than the biplanar assembly.
AO FIXERS
The small distraction and compression device for the use of
phalanges and metacarpals, the small external fixator for the
wrist, hand and foot.
This is the design of the tubular external fixator, it is simple,
easy to apply.
EXTERNAL FIXATORS
In general, external fixation is indicated when it is required to stabilize
bone segments and this cannot be done by another method (cast or
internal fixation), either due to local conditions of the affected
segment, or due to the characteristics of the patient (polytraumatized,
for example). )
COMPLICATIONS
■ Hemorrhage
■ wound infection
■ Thrombophlebitis
■ Loosening of tutors
SIGNS OF INFECTION

• Redness around the screw.

• Increase in temperature in the screw insertion area.
• Swollen or indurated skin.
• Increased pain in the screw insertion area.
• Fever.
CURE PROCEDURE IN PATIENTS WITH
GUARDIANS

EQUIPMENT AND MATERIAL AND SUPPLIES:

• Handling gloves
• Sterile gloves
• Sterile gauze
• Healing equipment
• Saline solution 0.9%
• antiseptic alcohol
PROCEDURE
> Wash your hands before and after the
procedure.

> Explain the procedure to the patient

> Put on handling gloves and remove the gauze

> Observe the insertion site for signs of infection: such as

inflammation, pain, purulent drainage, inform the doctor.
> Monitor the appearance of exudate at the insertion site, in
the first days there will be serous exudate, avoid scabs
forming at the entrance and exit of the nails.

> Put on sterile gloves and heal every 24 hours with 0.9%
saline solution from the center to the periphery for the first
3 days, starting on day 4, do so with sterile gauze soaked
with antiseptic alcohol and keep covered with gauze.
dry sterile.

> Dispose of waste according to regulations.

 > Inspect the fixator, since being purely mechanical it could
become destabilized due to loosening of the
The
pieces.

> If there is exudation, take it for culture and clean it more

frequently.
 NURSING CARE
IN PATIENTS WITH
TUTORS
 DECAY OF SKIN INTEGRITY
Definition: ALTERATION OF THE DERMIS OR EPIDERMIS.
Injury to muscle fascia, muscle, tendon,
cartilage, joint capsule and/or ligament.

NEED 08: Hygiene/skin

Pattern 02: Nutrition-Metabolic

Domain 11: Security / Protection

NOC Outcome Criteria

110201 Cutaneous approach

110213 Edge approximation Scale 1
of the wound
110214 Scar formation
110302 Granulation
110320 Scar formation Scale 1
110321 Decrease in the size of
the wound
 NANDA DIAGNOSIS

Deterioration of skin integrity related to (r/c) the external mechanical factors that caused the
trauma; and manifested by (m/p) the alteration, breakage and/or destruction of the skin layers
(epidermis / dermis).

INTERVENTIONS (NIC)

• Monitor the mobility, sensitivity, and peripheral neurovascularity of the

affected limb.
• Detect changes in skin color, nail bed, pain, mobility, the appearance of
edema, and local temperature.
• Help the bedridden patient in hygiene measures
staff .
• Moisturize the skin, make changes position every two hours
,minimize friction and shear forces when changing position.
• Use protective measures at the elbows and heels if warranted.
• Educate the patient on importance of a nutrition
and
fluid hydration.
• Promote a balanced diet, rich in proteins
and
vitamins
SELF-CARE DEFICIT DRESSING, BATHING

Definition: Definition: Impairment of capacity

of the person to perform or complete
by herself dress activities
and arrangement person

NEED 06: Get

dressed
Pattern Activity- exercise
04:
Domain 4: Activity / Rest

NOC Outcome Criteria

300 Personal care: activities of

daily living
301 Personal care: bath
305 Personal care: hygiene
 NANDA DIAGNOSIS

Self-care deficit: bathing r/c musculoskeletal deterioration m/p the patient

cannot perform bathing and hygiene independently.

INTERVENTIONS (NIC)
• Help the patient perform personal hygiene. Provide desired personal
items.
• Body bath for relaxation, cleansing and healing purposes.
• Control the patient's skin integrity.
• Carefully dry the interdigital spaces.
• Apply moisturizer to dry skin areas.
• Inspect the feet for irritation, cracks, lesions, deformities, or edema.
• Observe for vascular insufficiency in the lower legs.
• Observe if there is edema in the legs and feet.
RISK OF PERIPHERAL NEUROVASCULAR
DYSFUNCTION
Definition: Vulnerable to suffering an alteration in
circulation, sensitivity or mobility of an
extremity, which can compromise health

NEED M
04: o
v
P Activity-
e
at exercise
te
Do
r Safety/Protection
mai
n NOC Outcome Criteria
n
0
11:
4:
INDICATORS Scale 4
040706 Sensitivity
040707 Skin coloration
040708 Muscle function
240008 Paresthesias Scale 3
240011 Tingling
240012 Loss of sensation
NANDA DIAGNOSIS

Risk of peripheral neurovascular dysfunction r/c trauma; mechanical

compression.

INTERVENTIONS (NIC)

• Observe for paresthesia: numbness, tingling, hyperesthesia.

• Perform an assessment of peripheral circulation (e.g. e.g. Check
peripheral pulses, edema, capillary refill, color and temperature).
• Instruct the patient about the need to correct postures to avoid
fatigue, tension or injuries.
• Help the patient/family identify appropriate postural exercises.
• Provide information on possible position-related causes of muscle or
joint pain.
DEGRADATION OF PHYSIC MOVILITY
Definitio Limitation of independent, intentional
n: movement of the body or one or more
extremities.

NEED 04: Move

Pattern Activity- exercise

04:
Activity / Rest
Domain
4:
NOC Outcome Criteria
2 Ambulation: walk
0
206
0 active joint movement

208
Mobility level
209 muscle function

210 Carrying out the transfer

300 Personal care: activities of daily living

1811
Knowledge: prescribed activity
2102 Pain level
NANDA DIAGNOSIS

Impaired physical mobility r/c pain, inability to perform certain movements or

activity intolerance m/p limitation of range of motion.

INTERVENTIONS (NIC)
• Assess stability of the external fixator.
• Identify the activities that you can carry out autonomously,
those in which you require assistance and the degree and type
of this.
• Develop and implement an active and passive range of motion
exercise program.
• Adapt the physical environment to the person's capabilities as
much as possible.
• Assist in regular and rhythmic joint movement within the limits
of pain, resistance and joint mobility.
• Encourage sitting in bed, on the side of the bed, or in a chair,
as tolerated.
• Encourage walking, if appropriate
RISK OF INFECTION
Definitio Increased risk of being invaded
n:
by pathogenic microorganisms.

NEED 09: Avoid dangers/safety

Pattern Perception – health management

01:

Domain Security / Protection

11:

070208 Skin integrity Scale 4

070208 Mucosal integrity
070211 Current vaccinations
070308 Pain/Hypersensitivity Scale 3
 NANDA DIAGNOSIS

Risk of infection r/c invasive procedure (external fixator) and loss of skin
continuity

INTERVENTIONS (NIC)
• Wash hands before and after each patient care activity.
• Observe for signs and symptoms of systemic or localized infection.
(pain, heat, redness, edema)
• Administer antibiotics as prescribed.
• Ensure adequate hydration.
• Modify environmental conditions to provide good temperature, humidity
and adequate ventilation and air circulation free of contaminants.
• Maintain sterile dressing technique when performing wound care.
• Inspect the wound each time the dressing is changed.
• Regularly compare and record any changes in the wound.
ACUTE PAIN
Definition: Unpleasant sensory and emotional experience
caused by actual or potential tissue damage.

NEED 09: Avoid dangers/safety

Pattern 06: Cognitive-Perceptual

Domain 12: Comfort

NOC Outcome Criteria

210001 Physical well-being

210003 Psychological well-being
210008 Pain control
210201 Referred pain
210206 Facial expressions of pain
210209 Muscle tension
210214 Sweating
 NANDA DIAGNOSIS
Acute pain r/c trauma injury m/p verbal communication.

INTERVENTIONS (NIC)
• Perform a comprehensive pain assessment that includes location,
characteristics, onset/duration, frequency, quality, intensity or severity of
pain, and triggering factors.
• Establish a schedule for the administration of analgesics during cures or
when necessary to help achieve pain control.
• Provide accurate information on procedures to reduce stress and facilitate
pain control.
• Teaching non-pharmacological measures that can help reduce pain.
• Encourage adequate rest/sleep periods that facilitate pain relief.
• Apply cold to the affected site, if possible.
RISK OF CONSTIPATION
Definition: Risk of a decrease in the normal frequency of
defecation accompanied by difficult or incomplete
elimination of stool, or passage of hard, dry stools
NEED 03: Elimination

Pattern 03: Elimination

Domain 03: Disposal and Exchange

NOC Outcome Criteria

501 intestinal elimination

 NANDA DIAGNOSIS

Risk of constipation r/c insufficient physical activity

• INTERVENTIONS (NIC)
• Check bowel movements, including frequency, consistency, shape,
volume and color.
• Monitor for bowel sounds.
• Record the color, volume, frequency and consistency of stools.
• Instruct the patient/family about a diet rich in fiber and plenty of water.
• Instruct the patient/family on the correct use of laxatives.
• Instruct the patient/family about the relationship between diet,
exercise, and fluid intake for constipation.
• Evaluate the check-in for nutritional content.