orthopaedic complications orthopaedic complications
TRANSCRIPT
ORTHOPAEDIC ORTHOPAEDIC COMPLICATIONSCOMPLICATIONS
Objectives
• Identify the primary risk factors for orthopaedic complications
• Discuss the signs/symptoms of orthopaedic complications
• Describe common treatment for the primary orthopaedic complications
• Develop a nursing plan of care for specific orthopaedic complications
Potential Complications Potential Complications
Low RiskLow Risk Acute ConfusionAcute Confusion ConstipationConstipation Impaired Skin Impaired Skin
IntegrityIntegrity
High RiskHigh Risk DVT/PEDVT/PE Compartment Compartment
SyndromeSyndrome Fat Emboli SyndromeFat Emboli Syndrome HemorrhageHemorrhage Wound/Surgical Site Wound/Surgical Site
InfectionInfection Delayed/NonunionDelayed/Nonunion
Question # 1Question # 1
DVT prevention requires the nurse to educate the patient DVT prevention requires the nurse to educate the patient on anticoagulant therapy to be alert for : on anticoagulant therapy to be alert for :
1. Headache1. Headache
2. Epistaxis2. Epistaxis
3. Nausea3. Nausea
4. Chest pain4. Chest pain
Question # 1Question # 1
DVT prevention requires the nurse to DVT prevention requires the nurse to educate the patient on anticoagulant educate the patient on anticoagulant therapy to be alert for : therapy to be alert for :
2. Epistaxis2. Epistaxis
Venous Thromboembolic Venous Thromboembolic Conditions Conditions
VirchowVirchow’’s Triads Triad Endothelial injuryEndothelial injury Hypercoagulable stateHypercoagulable state VenostasisVenostasis
Deep Vein Thrombosis (DVT)Deep Vein Thrombosis (DVT)
Formation of fibrin leads to development Formation of fibrin leads to development of a thrombus (fibrin clot)of a thrombus (fibrin clot)
Clinical symptoms appear when thrombus Clinical symptoms appear when thrombus is large enough to impede blood flow in a is large enough to impede blood flow in a large vessellarge vessel
Pulmonary Embolism (PE)Pulmonary Embolism (PE)
When venous thrombosis or part of a When venous thrombosis or part of a thrombus dislodges from its primary site, it thrombus dislodges from its primary site, it becomes an embolusbecomes an embolus
Embolus can enter pulmonary circulation Embolus can enter pulmonary circulation and perfusion distal to the embolus can be and perfusion distal to the embolus can be partially or completely occludedpartially or completely occluded
DVT & PE: Risk Factors DVT & PE: Risk Factors
Patient relatedPatient related Increasing ageIncreasing age MalignancyMalignancy Varicose veinsVaricose veins ObesityObesity TraumaTrauma Prior DVT/PEPrior DVT/PE CHF/CVACHF/CVA PregnancyPregnancy Deficiencies in clotting Deficiencies in clotting
cascadecascade Oral contraceptivesOral contraceptives
DVT & PE: Risk Factors DVT & PE: Risk Factors (continued)(continued)
Procedure relatedProcedure related Pelvic, hip or leg Pelvic, hip or leg
surgery/ fracture surgery/ fracture fixationfixation
Surgery > 30 minutesSurgery > 30 minutes Postop immobilizationPostop immobilization Postop infectionPostop infection Re-operationsRe-operations
DVT & PE: Risk Factors DVT & PE: Risk Factors (continued) (continued)
Anesthesia relatedAnesthesia related General anesthesiaGeneral anesthesia
DVT: Clinical ManifestationsDVT: Clinical Manifestations
Unilateral swelling of Unilateral swelling of thigh/lower legthigh/lower leg
ErythemaErythema
WarmthWarmth
TendernessTenderness
Palpable, tender Palpable, tender venous cord in venous cord in popliteal spacepopliteal space
Discomfort in legDiscomfort in leg
DVT: DiagnosticsDVT: Diagnostics
Contrast venographyContrast venography
Doppler ultrasonographyDoppler ultrasonography
Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)
Radionuclide venographyRadionuclide venography
PE: Clinical ManifestationsPE: Clinical Manifestations
DyspneaDyspnea Chest painChest pain PalpitationsPalpitations ApprehensionApprehension ConfusionConfusion AnxietyAnxiety
RestlessnessRestlessness CoughCough HemoptysisHemoptysis DiaphoresisDiaphoresis SyncopeSyncope Distended neck veinsDistended neck veins
PE: DiagnosticsPE: Diagnostics Arterial blood gas (ABG)Arterial blood gas (ABG)
Chest x-ray (CXR)Chest x-ray (CXR)
Electrocardiogram (EKG)Electrocardiogram (EKG)
Ventilation-perfusion scan (VQ scan)Ventilation-perfusion scan (VQ scan)
Pulmonary angiographyPulmonary angiography
CT scan CT scan
DVT & PE: PreventionDVT & PE: Prevention
External pneumatic compression and External pneumatic compression and graduated compression stockingsgraduated compression stockings
Early ambulation and range of motionEarly ambulation and range of motion
Elevation of lower extremities Elevation of lower extremities
DVT & PE: Prevention (cont.)DVT & PE: Prevention (cont.)
Prophylactic inferior vena cava filter Prophylactic inferior vena cava filter
AnticoagulationAnticoagulationHeparinHeparinLMWH (low molecular weight heparin)LMWH (low molecular weight heparin)Warfarin (Coumadin)Warfarin (Coumadin)
DVT & PE: InterventionsDVT & PE: Interventions Full dose anticoagulation with heparin/warfarin Full dose anticoagulation with heparin/warfarin
(target INR 2-3)(target INR 2-3)
Oxygen therapy for PEOxygen therapy for PE
Thrombolytic therapyThrombolytic therapy urokinase, streptokinaseurokinase, streptokinase
Surgical embolectomySurgical embolectomy
Inferior vena cava filterInferior vena cava filter
Question # 2 Question # 2
The nurse uses critical thinking to assess an impending The nurse uses critical thinking to assess an impending compartment syndrome as indicated by which of the following compartment syndrome as indicated by which of the following patient presentations? patient presentations?
1. Progressive pain on PROM, paresthesia and diminished 1. Progressive pain on PROM, paresthesia and diminished
pulse pulse
2. Progressive pain on AROM, shiny skin and pulselessness2. Progressive pain on AROM, shiny skin and pulselessness
3. Progressive pain on AROM, increased tissue pressure 3. Progressive pain on AROM, increased tissue pressure and edemaand edema
4. Progressive pain on PROM and elevated ESR & WBC4. Progressive pain on PROM and elevated ESR & WBC
Question # 2Question # 2
The nurse uses critical thinking to assess The nurse uses critical thinking to assess an impending compartment syndrome as an impending compartment syndrome as indicated by which of the following patient indicated by which of the following patient presentations? presentations?
1. Progressive pain on PROM, paresthesia 1. Progressive pain on PROM, paresthesia
and diminished pulse and diminished pulse
Compartment SyndromeCompartment Syndrome
Compromised Compromised circulation and circulation and function of tissues function of tissues within a specific area within a specific area due to progressive due to progressive pressure within a pressure within a confined spaceconfined space
Acute, chronic or Acute, chronic or crushcrush
Compartment Syndrome: Compartment Syndrome: PathophysiologyPathophysiology
Tissue swellingTissue swelling Compression of vessels and nervesCompression of vessels and nerves Histamine releaseHistamine release Capillary dilationCapillary dilation Increase in capillary permeabilityIncrease in capillary permeability Increased edemaIncreased edema Decreased perfusionDecreased perfusion Increased lactic acidIncreased lactic acid Increased blood flowIncreased blood flow
Compartment Syndrome: Compartment Syndrome: Risk FactorsRisk Factors
External compression External compression forcesforces Tight castTight cast Tight dressing Tight dressing Prolonged compressionProlonged compression Crush injuries Crush injuries
Internal factorsInternal factors BleedingBleeding Significant swelling/edemaSignificant swelling/edema Exertional Exertional
Compartment Syndrome:Compartment Syndrome: Risk Factors (continued) Risk Factors (continued)
MiscellaneousMiscellaneous Acute traumaAcute trauma FractureFracture InfectionInfection Skin tractionSkin traction Tibial nailingTibial nailing ExerciseExercise Insensate extremityInsensate extremity
Compartment Syndrome:Compartment Syndrome:Clinical ManifestationsClinical Manifestations
Early signsEarly signs Increasing painIncreasing pain Pain with passive Pain with passive
stretch of musclesstretch of muscles ParesthesiaParesthesia
Late signsLate signs Delayed capillary Delayed capillary
refillrefill Pale extremityPale extremity Loss of pulseLoss of pulse ParalysisParalysis
Compartment Syndrome:Compartment Syndrome: 5 Ps 5 Ps
Pain on passive Pain on passive stretchstretch
Pallor Pallor PulselessnessPulselessness ParesthesiaParesthesia ParalysisParalysis
Compartment Syndrome: Compartment Syndrome: MonitoringMonitoring
If compartment syndrome is not If compartment syndrome is not recognized and pressure is not relieved, recognized and pressure is not relieved, muscle damage will be irreversible after muscle damage will be irreversible after 4-6 hours of ischemia, and nerve 4-6 hours of ischemia, and nerve damage will be irreversible after 12-24 damage will be irreversible after 12-24 hours of ischemia. (Janzing et al., 1996)hours of ischemia. (Janzing et al., 1996)
Neurovascular Assessment Neurovascular Assessment
Peripheral vascular assessmentPeripheral vascular assessment ColorColor
pale/white, pink, dusky, pale/white, pink, dusky, cyanotic, mottledcyanotic, mottled
TemperatureTemperature cool/cold, warm, hotcool/cold, warm, hot
Capillary refillCapillary refill normal < 3 secondsnormal < 3 seconds
Peripheral pulsesPeripheral pulses distal to injury, bilateraldistal to injury, bilateral non-palpable: dopplernon-palpable: doppler
Edema Edema pitting pitting
Neurovascular AssessmentNeurovascular Assessment
Peripheral neurologic Peripheral neurologic assessmentassessment SensationSensation Motor functionMotor function
Both elements Both elements evaluate:evaluate:
Upper extremity: Upper extremity: radial, median and radial, median and ulnar nervesulnar nerves
Lower extremity: Lower extremity: tibial, peroneal, tibial, peroneal, femoral and sciatic femoral and sciatic nervesnerves
Compartment Syndrome:Compartment Syndrome:DiagnosticsDiagnostics
Muscle damage indicated by:Muscle damage indicated by:Myoglobin in urineMyoglobin in urineElevated CPK, LDH and SGOTElevated CPK, LDH and SGOT
Intracompartmental pressure monitorIntracompartmental pressure monitorPressures of 30-45 mmHG a concernPressures of 30-45 mmHG a concern
Compartment Syndrome:Compartment Syndrome:PreventionPrevention
Early recognition is key to Early recognition is key to preventing or minimizing preventing or minimizing negative outcomenegative outcome
Astute nursing Astute nursing intervention to identify intervention to identify pathologic pain in the pathologic pain in the presence of good pain presence of good pain control (epidural, PCA)control (epidural, PCA)
Compartment Syndrome:Compartment Syndrome:InterventionsInterventions
Relieve pressure sourceRelieve pressure source Remove constrictive dressingRemove constrictive dressing Bivalve castBivalve cast
Initiate pain managementInitiate pain management
Elevate extremity at heart levelElevate extremity at heart level
Ongoing neurovascular assessments Ongoing neurovascular assessments Fasciotomy if indicatedFasciotomy if indicated
Question # 3Question # 3
Which nursing assessment finding might Which nursing assessment finding might suggest the presence of a fat embolism?suggest the presence of a fat embolism?
1.1. EcchymosisEcchymosis
2.2. HematomaHematoma
3.3. PetechiaePetechiae
4.4. Edema Edema
Question # 3Question # 3
Which nursing assessment finding might Which nursing assessment finding might suggest the presence of a fat embolism?suggest the presence of a fat embolism?
3. Petechiae3. Petechiae
Fat Emboli Syndrome (FES)Fat Emboli Syndrome (FES)
Mechanical blockage Mechanical blockage of blood vessels by of blood vessels by circulating fat circulating fat particles particles
Occurs following long Occurs following long bone fracture, pelvic bone fracture, pelvic fracture and total hip fracture and total hip arthroplasty arthroplasty
FES: PathophysiologyFES: Pathophysiology
Mechanical theoryMechanical theory Injured adipose tissue Injured adipose tissue
and/or disruption of and/or disruption of intramedullary intramedullary compartment releases compartment releases fat into the blood fat into the blood streamstream
Biochemical theoryBiochemical theory Fatty acids cause Fatty acids cause
endothelial damage; endothelial damage; fatty acids and fats fatty acids and fats lead to platelet lead to platelet aggregation and fat aggregation and fat globule formation globule formation
FES: Clinical ManifestationsFES: Clinical Manifestations
Signs and symptoms Signs and symptoms can appear 12-72 can appear 12-72 hours post injuryhours post injury Change in mental Change in mental
statusstatus Increased respiratory Increased respiratory
distressdistress Petechiae of skin & Petechiae of skin &
mucosa (appear mucosa (appear above nipple line and above nipple line and blanch)blanch)
FES: DiagnosticsFES: Diagnostics
No specific labsNo specific labs Fat globules may be Fat globules may be
detected in blood, detected in blood, urine or sputumurine or sputum
PO2 drops to < 50 PO2 drops to < 50 mmHGmmHG
CXR with diffuse CXR with diffuse ““snowstormsnowstorm”” effect effect
VQ scan to r/o PEVQ scan to r/o PE
FES: InterventionsFES: Interventions
Early recognition to Early recognition to prevent morbidity and prevent morbidity and mortalitymortality
Minimize movement Minimize movement of long bone fracturesof long bone fractures
Respiratory supportRespiratory support IntubationIntubation Ventilator Ventilator
managementmanagement ICU monitoring ICU monitoring
Question 4AQuestion 4A
Which indicators are BEST for diagnosing Which indicators are BEST for diagnosing hemorrhagehemorrhageA) Blood in urine/stoolA) Blood in urine/stoolB) Labs (cbc, coagulation studies)B) Labs (cbc, coagulation studies)C) Radiographic studiesC) Radiographic studies
Hemorrhage/Postoperative Hemorrhage/Postoperative Bleeding Bleeding
EtiologyEtiology Trauma/surgeryTrauma/surgery Slipped ligatureSlipped ligature Anticoagulation or Anticoagulation or
coagulation disordercoagulation disorder Erosion of blood Erosion of blood
vessel by foreign body vessel by foreign body or tumoror tumor
Infection Infection
Hemorrhage: Risk FactorsHemorrhage: Risk Factors
Patient-relatedPatient-related Coagulation disordersCoagulation disorders Low platelet countLow platelet count Excessive coagulationExcessive coagulation Tumor growthTumor growth
Injury-relatedInjury-related Fracture or foreign body interrupts blood vesselFracture or foreign body interrupts blood vessel
Procedure-relatedProcedure-related
Hemorrhage: Hemorrhage: Clinical Manifestations Clinical Manifestations
DizzinessDizziness WeaknessWeakness AnxietyAnxiety RestlessnessRestlessness ConfusionConfusion TachycardiaTachycardia Lowered BPLowered BP
Rapid, shallow Rapid, shallow respirationsrespirations
PallorPallor Cold, clammy skinCold, clammy skin Abnormal drainage Abnormal drainage
from wounds or from wounds or drainsdrains
Decreased urine Decreased urine output output
Hemorrhage: Hemorrhage: DiagnosticsDiagnostics
CBCCBC
Coagulation studies Coagulation studies
Urine and stool for Urine and stool for bloodblood
Radiographic studies Radiographic studies
Hemorrhage: InterventionsHemorrhage: Interventions Direct pressureDirect pressure
Surgical intervention as indicatedSurgical intervention as indicated
Use of autologous or synthetic clotting materialUse of autologous or synthetic clotting material
Vitamin K or clotting replacement factorsVitamin K or clotting replacement factors
Volume replacement and blood transfusion as necessaryVolume replacement and blood transfusion as necessary
Iron supplementationIron supplementation
Question # 4
To prevent nosocomial wound/surgical site infection, the most important intervention the nurse should perform is:
1. Thorough handwashing
2. Aseptic technique with dressing changes
3. Administration of antibiotic
4. Monitoring BP and glucose levels
Question # 4Question # 4
To prevent nosocomial wound/surgical site infection, the most important intervention the nurse should perform is:
1. Thorough handwashing
Wound and Surgical Site Wound and Surgical Site Infection (SSI)Infection (SSI)
Nosocomial surgical site infections Nosocomial surgical site infections occur within 30 days after the operative occur within 30 days after the operative procedure (within 1 year if an implant is procedure (within 1 year if an implant is in place) and can involve skin, in place) and can involve skin, subcutaneous tissue, deep soft tissues, subcutaneous tissue, deep soft tissues, or actual organs manipulated during the or actual organs manipulated during the operative procedure. (CDC)operative procedure. (CDC)
Wound/SSI: Risk FactorsWound/SSI: Risk Factors
Patient characteristicsPatient characteristics Advanced ageAdvanced age Obesity/malnutritionObesity/malnutrition HypovolemiaHypovolemia DiabetesDiabetes Rheumatoid arthritisRheumatoid arthritis Steroid use/NSAID Steroid use/NSAID
use/chemotherapyuse/chemotherapy Tobacco useTobacco use Substance abuse Substance abuse
Wound/SSI: Wound/SSI: Intrinsic Risk FactorsIntrinsic Risk Factors
Injury characteristicsInjury characteristicsBone displacement, comminutionBone displacement, comminutionPeriosteal strippingPeriosteal stripping Involvement of more than one boneInvolvement of more than one boneVascular injuryVascular injurySignificant soft tissue injurySignificant soft tissue injuryOpen fracture/foreign body/contamination Open fracture/foreign body/contamination
Wound/SSI:Wound/SSI:Extrinsic Risk FactorsExtrinsic Risk Factors
PreoperativePreoperative Inadequate Inadequate
immobilization of immobilization of fractured bonefractured bone
Preoperative shave > Preoperative shave > 1 day prior to surgery1 day prior to surgery
Duration of Duration of preoperative preoperative hospitalization hospitalization
IntraoperativeIntraoperative Hair removalHair removal Positive intraop Positive intraop
contaminationcontamination Irrigation, drains, packingIrrigation, drains, packing Primary/secondary Primary/secondary
closures closures Type and length of Type and length of
procedureprocedure Surgeon expertiseSurgeon expertise Glove punctures Glove punctures
Wound/SSI:Wound/SSI: Extrinsic Risk Factors Extrinsic Risk Factors
PostoperativePostoperative Cold room Cold room
(vasoconstriction)(vasoconstriction) Insufficient fluid Insufficient fluid
replacementreplacement HypertensionHypertension Inadequate analgesiaInadequate analgesia Compromised blood Compromised blood
perfusionperfusion Low oxygenation Low oxygenation
Wound/SSI: Wound/SSI: Clinical ManifestationsClinical Manifestations
Increased painIncreased pain
Fever or chillsFever or chills
Malodor from incision or Malodor from incision or wound wound
EdemaEdema
Increased temperature Increased temperature around incision or woundaround incision or wound
Erythema around wound Erythema around wound or incisionor incision
Purulent exudate, poor Purulent exudate, poor wound healingwound healing
Elevated WBC, ESR, C-Elevated WBC, ESR, C-reactive protein reactive protein
Wound/SSI: PreventionWound/SSI: Prevention
PreoperativePreoperative Control hypertension Control hypertension
and blood sugar and blood sugar Minimize unnecessary Minimize unnecessary
movement of fracturesmovement of fractures Treat existing Treat existing
infectionsinfections Replenish nutritional Replenish nutritional
deficitsdeficits Prevent Prevent
vasoconstrictionvasoconstriction
IntraoperativeIntraoperative Antimicrobial prophylaxisAntimicrobial prophylaxis Strict aseptic techniqueStrict aseptic technique Meticulous tissue Meticulous tissue
debridementdebridement Stabilize fracturesStabilize fractures Avoid vasoconstrictionAvoid vasoconstriction Gently handling of soft Gently handling of soft
tissuetissue Wound closure without Wound closure without
excessive tension excessive tension
Wound/SSI: PreventionWound/SSI: Prevention
PostoperativePostoperative Provide adequate Provide adequate
analgesiaanalgesia Avoid vasoconstrictionAvoid vasoconstriction Control BP and BSControl BP and BS Provide for adequate Provide for adequate
nutritionnutrition Aseptic dressing changesAseptic dressing changes Microbial therapy Microbial therapy Thorough handwashing Thorough handwashing
Wound/SSI: InterventionsWound/SSI: Interventions
Wound careWound care Systemic antibioticsSystemic antibiotics Adequate perfusionAdequate perfusion Adequate Adequate
oxygenationoxygenation Optimal nutritional Optimal nutritional
intake intake
Question #5Question #5
A fracture that isn’t healing is considered A fracture that isn’t healing is considered to be a non union (as opposed to a to be a non union (as opposed to a delayed union) fracture after how long?delayed union) fracture after how long?
6-12 weeks6-12 weeks8-14 weeks8-14 weeks16-24 weeks16-24 weeks28-36 weeks28-36 weeks
Delayed Union/NonunionDelayed Union/Nonunion
Delayed union is a continuation of or increase in Delayed union is a continuation of or increase in bone pain and tenderness beyond a reasonable bone pain and tenderness beyond a reasonable healing period; healing is slowed but not healing period; healing is slowed but not completely stoppedcompletely stopped
Nonunion occurs when fracture healing has not Nonunion occurs when fracture healing has not taken place 4-6 months after the fracture occurs taken place 4-6 months after the fracture occurs and spontaneous healing is unlikely (Morris, and spontaneous healing is unlikely (Morris, 2001)2001)
Delayed Union/NonunionDelayed Union/Nonunion
PathophysiologyPathophysiology InfectionInfection Inadequate fracture Inadequate fracture
immobilizationimmobilization Inadequate blood Inadequate blood
supply to fracture sitesupply to fracture site
DiagnosticsDiagnostics Serial x-raysSerial x-rays CT scansCT scans MRI MRI
Delayed Union/Nonunion:Delayed Union/Nonunion:Interventions Interventions
Bone graftingBone grafting
Internal fixation Internal fixation
External fixationExternal fixation
Electrical bone Electrical bone stimulation stimulation
Question # 1Question # 1
DVT prevention requires the nurse to educate the patient DVT prevention requires the nurse to educate the patient on anticoagulant therapy to be alert for : on anticoagulant therapy to be alert for :
1. Headache1. Headache
2. Epistaxis2. Epistaxis
3. Nausea3. Nausea
4. Chest pain4. Chest pain
Question # 1Question # 1
DVT prevention requires the nurse to DVT prevention requires the nurse to educate the patient on anticoagulant educate the patient on anticoagulant therapy to be alert for : therapy to be alert for :
2. Epistaxis2. Epistaxis
Question # 2 Question # 2
The nurse uses critical thinking to assess an impending The nurse uses critical thinking to assess an impending compartment syndrome as indicated by which of the following compartment syndrome as indicated by which of the following patient presentations? patient presentations?
1. Progressive pain on PROM, paresthesia and diminished 1. Progressive pain on PROM, paresthesia and diminished
pulse pulse
2. Progressive pain on AROM, shiny skin and pulselessness2. Progressive pain on AROM, shiny skin and pulselessness
3. Progressive pain on AROM, increased tissue pressure 3. Progressive pain on AROM, increased tissue pressure and edemaand edema
4. Progressive pain on PROM and elevated ESR & WBC4. Progressive pain on PROM and elevated ESR & WBC
Question # 2Question # 2
The nurse uses critical thinking to assess The nurse uses critical thinking to assess an impending compartment syndrome as an impending compartment syndrome as indicated by which of the following patient indicated by which of the following patient presentations? presentations?
1. Progressive pain on PROM, paresthesia 1. Progressive pain on PROM, paresthesia
and diminished pulse and diminished pulse
Question # 3Question # 3
Which nursing assessment finding might Which nursing assessment finding might suggest the presence of a fat embolism?suggest the presence of a fat embolism?
1.1. EcchymosisEcchymosis
2.2. HematomaHematoma
3.3. PetechiaePetechiae
4.4. Edema Edema
Question # 3Question # 3
Which nursing assessment finding might Which nursing assessment finding might suggest the presence of a fat embolism?suggest the presence of a fat embolism?
3. Petechiae3. Petechiae
Question 4AQuestion 4A
Which indicators are BEST for diagnosing Which indicators are BEST for diagnosing hemorrhagehemorrhageA) Blood in urine/stoolA) Blood in urine/stoolB) Labs (cbc, coagulation studies)B) Labs (cbc, coagulation studies)C) Radiographic studiesC) Radiographic studies
Question # 4
To prevent nosocomial wound/surgical site infection, the most important intervention the nurse should perform is:
1. Thorough handwashing
2. Aseptic technique with dressing changes
3. Administration of antibiotic
4. Monitoring BP and glucose levels
Question # 4Question # 4
To prevent nosocomial wound/surgical site infection, the most important intervention the nurse should perform is:
1. Thorough handwashing
Question #5Question #5
A fracture that isn’t healing is considered A fracture that isn’t healing is considered to be a non union (as opposed to a to be a non union (as opposed to a delayed union) fracture after how long?delayed union) fracture after how long?
6-12 weeks6-12 weeks8-14 weeks8-14 weeks16-24 weeks16-24 weeks28-36 weeks28-36 weeks