OPEN REDUCTION INTRAMEDULLARY NAILING OF TIBIA, RIGHT CONSIDERATIONS the condition of the surrounding soft tissues, the number

er of fragments, movement of fragments, possibility of compartment syndrome, associated injuries, duration of the reparation process, complications. Complications Most common post-operative complications are: deep vein thrombosis and pulmonary embolism, compartment syndrome, extensive hemathoma that needs to be to be drained, infection of soft tissues and bones, bacteraemia and sepsis, fracture of the locking screws, fracture of the intramedullary nail. Clinical Manifestation Pain bone fragment are immobilized, direct tissue trauma and muscle spasm. Loss of function - because normal function of the muscles depends on the integrity of the bones to which they are attached. Deformity - Displacement, angulation, or rotation of the fragments in a fracture of the arm or leg causes a deformity

 Shortening shortening of the extremity because of the contraction of the muscle that are attached above and below the site of the fracture. Crepitus - It is caused by the rubbing of the bone fragments against each others. Swelling and discoloration It is caused trauma and bleeding into the tissue Numbness - Fracture can cause nerve damage that can felt numbness Muscle spasm - A fracture can cause muscle spasm near the fracture IMMEDIATE COMPLICATION Systemic Hypovolemic shock excessive blood loss may occur from vascular fracturesurface or injury to major vessel Local Injury to nerves Injury to muscle and tendons Injury to blood vessel Injury to joints Injury to viscera EARLY COMPLICATION Systemic Hypovolemic shock Fat embolism Aseptic traumatic fever Septicemia Crush syndrome Local Infection Compartment syndrome LATE COMPLICATION Delayed union Non-union Mal-union Cross-union Shortening Joint stiffness Osteomyelitis

Purposes 1. Immobilization the bone 2. Maintain alignment of the bone 3. Reduce pain Complication Pre Operative 1.Re explain about the operation and purpose, time, date of the operation To ensure patient understand about the operation 2.Ensure the consent sign by doctor, patient, and nurse as a witness (staff nurse) As a hospital protocol 3.Ask patient to Nil By Mouth (NBM) within 12 hours before the operation To prevent from vomiting during operation that can cause aspiration 4.Take vital sign Temperature, pulse, respiration, blood pressure and weight As a baseline data to detect any abnormalities 5.Do check list such as remove the jewelery, denture, and any material thing To prevent from disturb the operation 6. Do skin preparation as ordered by doctor To reduce transmission of microorganism that can cause infection 7.Give patient OT gown and ensure patient remove all the clothes As a hospital policy during surgery Infection Non-union Implant failure Re-fracture

8.Ensure patient empty bladder and bowel preparation To promote comfort 9.Administer pre medication as ordered by doctor. To reduce anxiety 10.Teach and demonstrate to the patient about deep breathing exercise (DBE). To patient applied after post -operative if patient having pain. Post -Operative 4. Monitor drainage (amount, color) and record in intake and output chart. To detect early if have any sign and symptom of bleeding. 5. Keep patient Nil By Mouth (NBM) until patient have gag reflex feel (6 8 hours) To prevent from vomiting that can cause aspiration 6. Administer medication as ordered by doctor such as IM Nubain 10 mg and T.Ultracet 2 tablet To reduce pain. 7. Observe patient bowel movement such as passing urine To prevent bladder distended. 8. Monitor neurovascular status every 4 hours. To detect any abnormalities.