Hi -

Recently a student nurse asked me about turning a patient with a fx hip before her ORIF - an 81 yo woman with some cardiac instability needing resolution and on Coumadin so had to wait for INR to come down. She was on a med-surg unit for 3-4 days before going to OR.

Do you turn these pts (back to unaffected side)? Do you put them on air mattress?

Thanks

Yes, and yes. A patient in traction needs turned and/or repositioned every 2 hours. And good skin care with each turn. Remove weights, pillow between legs with affected leg supported as you turn. Reposition traction pulleys and rehang weight. Some facilities dont use buck's traction anymore, but we find the patients are more comfortable with the buck's applied.

A waffle is appropriate if the patient is at risk. Also, were they doing something to bring the pro-x's down? Surely they were treating the problem?

Yes, and yes. A patient in traction needs turned and/or repositioned every 2 hours. And good skin care with each turn. Remove weights, pillow between legs with affected leg supported as you turn. Reposition traction pulleys and rehang weight. Some facilities dont use buck's traction anymore, but we find the patients are more comfortable with the buck's applied.

A waffle is appropriate if the patient is at risk. Also, were they doing something to bring the pro-x's down? Surely they were treating the problem?

Yes - they handled the coagulation problem fine (finally had to give her Vit K to get her INR and pro times WNL. It was just the skin care issue that concerned me. I am not an ortho nurse so after I said "Of course" to the student, I backed off and said "Let's check" just in case preventing adduction etc was not adequate. The patient was not in traction and was on a regular mattress. She developed a sacral decub, which is why the issue came up.

Thanks for the info

I'm surprised they didnt give her a dose of vit K right off if they found her prox's to high on admission. 3-4 days is a long time for a patient to have to wait for repair or replacement after a fracture. They like to go as soon as possible to avoid the swelling and bruising that comes after 24 hours. Glad they got it done but that is still a long time for a patient to have to wait. Werent they having horrible muscle spasms? The traction helps decrease the muscle spasms associated with the fracture.

I'm surprised they didnt give her a dose of vit K right off if they found her prox's to high on admission. 3-4 days is a long time for a patient to have to wait for repair or replacement after a fracture. They like to go as soon as possible to avoid the swelling and bruising that comes after 24 hours. Glad they got it done but that is still a long time for a patient to have to wait. Werent they having horrible muscle spasms? The traction helps decrease the muscle spasms associated with the fracture.

I was not on same unit with pt - on a telemetry unit; just knew student, who was tech on our unit. Anyway....apparently docs gave first dose Vit k (5 mg)

~ 40 hrs p admission, then another dose (10 ng) 24 hrs p that. Pro x's/INR were 27.0/2.6 on admit; 32.6/3.1 next day; 34.3/3.2 at 38 hrs;

27.9/2.6 p 1st dose Vit K; 17.4/1.6 p 2nd dose - students take great notes about labs :).......Dilaudid 1mg then 2 mg q3h for pain (but student could not remember any comments about muscle spasms, only external rotation as cause....

Pt ended up with big sacral decub 4 days p admit - found in OR - so your point is well taken about value of Vit K earlier --> OR earlier. And post op care (in surg ICU bcse of cardiac hx) which included frequent T&P to pt's benefit

Wow,, bet someone got a whoppin chewing for that decub. To bad, hope the patient is back on their feet. We have problems with people getting turned also. We have to keep after and keep after staff to keep patients turned and have them using the IS.

Funny,, noone has time to turn and reposition people but they have time to sit around and yack. UGhhhh,, so frustrating.

We did it differently. The affected hip is on the down side. The theory is the bed splints the leg in good position rather than draping the leg over pillows. It was almost universal where I worked.