Locked, Intramedullary nailing (IM) has been accepted as the standard treatment mechanism for displaced tibial shaft fractures. The purpose of carrying out a surgical procedure is to reunite two displaced bones, especially after accidental injuries or any other form of trauma. The procedure helps to preserve soft-tissue sleeve around the area of fracture and allows joints close the fracture site to achieve early motion and stability (Zelle & Boni, 2015). Patients with high risk of a non-healing wound, people with compromised tissue, and distal bone tissue that allow insertion of two screws are characteristic of the circumstances under which IM nailing procedure can be undertaken(Mao et al., 2015).
The safety of a surgical procedure depends on the ability of nurses, surgeons and other members of the surgical team to communicate effectively. In these settings, verbal, written and electronic platforms are used. As soon as the surgical teams enter the operation room, the clinicians and nurses who prepared the patient provide a handover of the case after which participants in the surgery pause for a briefing of the case and the plan of action. Here, two critical communications take place: the signing in before the anesthesia is administered and the signing out procedure before any skin incision is done on the patient (Cumin, Skilton, & Weller, 2016). These processes involve both verbal and written communication.
Once the surgical teams have sterilized themselves, they are not allowed to hold any communication equipment. Electronic tools facilitate immediate communication to ensure the surgical activity proceeds according to plan and enable the teams to monitor the surgical process throughout the surgical period (Malley, Kenner, Kim, & Blakeney, 2015). After completion of the surgical procedure, electronic and written documentation are done.
Preoperative Nursing Interventions
Reconciling and integrating patient data from different sources
Assisting the anesthetic to administer the anesthesia
Doing skeletal traction
Arterio-vein ultrasonic examination of the lower limb
Managing transition between primary care and preoperative teams(Zhang, 2015)
Intraoperative Nursing Interventions
Traction and fixation of the wounded limbs
Inspection of the patient's consciousness and breath
Postoperative Nursing Interventions
Liaising with the anesthetic to take the patient back to the ward
Monitoring of oxygen flow
Supervision of blood pressure of the operated patient
Assisting the patient to take sleep flat and positioning the operated limbs in such way that it avoids abduction, international rotation and external rotation
Management of surgical infection (Malley, et., 2015).
Patient Education Nursing Interventions
Pre-operative Education Nursing Interventions
Management of patient stress. This involves assessment of the level of fear of the patient regarding the possibility of leg mutilation or inability to walk again.
Communication of patient vulnerabilities. The nurse clarifies concerns of patients and relays them to other surgical teams.
Sensitize patients of their expectations during the operation. This is meant to reduce anxiety and medical errors during the operation.
Education on pain management. This information reassures patients about the outcome of the surgery.
Providing information about diet. The period before surgery requires that patients avoid certain foods considered due to influence bleeding (Zhang, 2015).
Postoperative Education Nursing Interventions
Education of patient's diet. Since many patients feel constipated after surgery, they are given information on the need to have fruits and fiber intake.
Assisting patients in doing weight-bearing excises. Exercises are usually done six weeks after the operation to help patients relive pain while making attempts to walk
Education on adherence to prescribed medication. Proper medication hastens the healing process.
Management of surgical infection. Patients are taught on how to keep their surgical wounds dry or free from infections.
Pain management. Patients experience pain after the exhaustion of the anesthesia. Thus, they need information on how to cope with the wound and how long it would last during recovery and what can be done to minimize the pain (Zhang, 2015).
Cumin, D., Skilton, C., & Weller, J. (2016). Information transfer in multidisciplinary operating room teams: a simulation-based observational study. BMJ Quality & Safety, 26(3), 209-216. doi:10.1136/bmjqs-2015-005130
Malley, A., Kenner, C., Kim, T., & Blakeney, B. (2015). The role of the nurse and the preoperative assessment in patient transitions. AORN Journal, 102(2), 181.e1-181.e9. doi:10.1016/j.aorn.2015.06.004
Mao, Z., Wang, G., Zhang, L., Zhang, L., Chen, S., Du, H., ... Tang, P. (2015). Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. Journal of Orthopaedic Surgery and Research, 10(1), 1-12. doi:10.1186/s13018-015-0217-5
Zelle, B. A., & Boni, G. (2015). Safe surgical technique: intramedullary nail fixation of tibial shaft fractures. Patient Safety in Surgery, 9(1), 1-17. doi:10.1186/s13037-015-0086-1
Zhang, Y. (2015). The perioperative nursing of treating the elderly patients of femoral intertrochanteric fracture with PFNA. Journal of Nursing, 4(1), 1-4. doi:10.18686/jn.v4i1.1
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