MANAJEMEN

KEPERAWATAN KLIEN
ORTOPEDI

Dr. Masfuri, SKp, MN

Objective

• Konsep dasar fraktur

• Proses penyembuhan
• Pengkajian
• Manajemen dan Asuhan
Keperawatan
 Fungsi Muskuloskelatal
1. Gerak tubuh
2. Posture
3. Proteksi organ penting
4. Produksi panas
5. Pernafasan
6. Kontriksi pembuluh darah
7. Produksi sel darah merah
8. Dll
 Fraktur (1)
• Penyebab utama: tauma
• Discontinuitas atau patahnya jaringan
tulang
• Berdampak pada jaringan lunak sekitar:
pembuluh darah, syaraf, otot dan organ
– Extremitas à atas/bawah à mobilisasi
– Spine à SCI
– Kepala à brain injuri
– Dada à hemo-pneumothoraks
 Fraktur (2)
• 150 jenis fraktur, klasifikasi menjadi: incomplete,
complete, closed, open, and pathologic
• Traumatic amputations, fractures, dislocations,
cedera jaringan lunak (sprains and strains), dan
cdera jaringn lunak (hematomas and contusions).
• Komplikasi akut: compartment syndrome, fat
embolism, hemorrhage, osteomyelitis and septic
arthritis
• Penyebab lain: osteoporosis, tumor, infeksi
• Morbiditas, 6.8 jt/tahun di US. 70% usia >45 th
 Waspadai: Komplikasi akut
Local vs Systemic
• Shock
• Visceral injury (the lung, the – Hypovolemic or
bladder, the urethra, and the hemorrhagic shock.
rectum). – Septic shock.
• Vascular injury – Neurogenic shock.
• Nerve injury • Fat embolism
• Compartment syndrome • Pulmonary embolism
• Haemoarthrosis • Crush syndrome
• Infection • Multiple organs failure
• Gas gangrene syndrome (MOFS)
• Fracture blisters • Thrombo-embolism
• Plaster and pressure sores • Tetanus
Bone and Blood Vessel
Waspadai: Complete Fracture
Rongga: dada, abdomen, pelvis,
tulang Panjang
Potensi perdarahan:
• Rib: 100 – 200 cc
• Tibia: 300 - 500 cc
• Femur: 800 - 1200 cc
• Pelvis: 1500 cc – lebih
 Fracture and Blood Loss

No Lokasi Fraktur Estimasi Vol Keluar % Kehilangan Derajat Syok

1 Rib (satu) 125-200 ml 5 1
2 Radius/Ulna 250-500 ml 10 1
3 Humerus 500-1000ml 10-20 2
4 Tibia/fibula 500-1000ml 10-20 2
5 Femur 500-2000ml 10-40 3
6 Pelvis 2000-3000ml 60% 4
Kehilangan darah & shock

https://www.researchgate.net/publication/227027828_Gastrointestinal_Bleeding/figures?lo=1
 Contoh Fr Femur
fraktur ekstremitas bawah disebabkan oleh
WHO kecelakaan sebesar 40%, cacat fisik 1,3 juta
( 2011 & 2013) orang dan tahun 2013-2017 : 5,7 juta orang
meninggal dunia dan 1,3 juta orang
meninggal kecelakaan lalu lintas .

fraktur akibat kecelakaan prevalensi nya 67,

FRAKTUR Riskesdas 9%. Dari 92.976 kasus fraktur ekstermitas
(2018) bawah, 19.754 orang mengalami fraktur
FEMUR
femur,

Hampir 60% dari fraktur femoralis bagian

Link & Babst, distal terjadi pada kelompok usia >50 tahun
2012). akibat osteoporosis
 Prinsip Penatalaksanaan Fraktur
Black (2014), Smeltzer (2010), Patterno (2006) dan Deghan (2018)

Memastikan Mencegah Gerakan

Keadaan Frakmen fraktur

Rekognisi Reduksi Imobilisasi Rehabilitasi

Kesegarisan Mengembalikan
tulang fungsi
Clinical Pathway (c0ntoh)

DOI:
10.2174/1874325001711010309
 contoh

Donegan, Derek, Kelsey Bonilla, Rachel Kleinman, and Samir Mehta. 2021. “A Geriatric Hip Fracture Care Pathway: An Operational
Approach to Quality Improvement.” Journal of Orthopaedic Experience & Innovation, January.
Patoflow fraktur
KELOMPOK 2: Ekberth Mandaku,Irawati, Nila Indrayati, Rika Diah Pitaloka , Santi Apriyani
Apa yng anda
pikirkan dari 3
slide ini?
 Penyembuhan Fraktur
1. Perdarahan dan hematom (72 jam).
2. haematoma menuju granulasi (3-14 hari)
3. Invasi osteoblasts, permanjangan and
deposit of calcium (2nd minggu).
4. Callus formation: tulang baru terbentuk.
Osteoclastshancurkan tulang mati (3wk -
6mn). Boleh Gerak terbatas
5. Remodeling: calus diabsorbsi (up to 1 yr).

10/22/22 MaS FIK 17

10/22/22 masfuri
 What we have to do?
• Meningkatkan faktor pendukung
– Apa saja?
– Bagaimana upaya ners?

• Meminimalkan faktor
penghambat
– Apa saja?
– Bagaimana upaya ners?
 Assessment: emergency
LISTEN à LOOK à FEEL à MOVE

• Primer: • Sekunder (lanjut)

– ABC – AGD
–6P – X-ray dll
– PQRST – Head – toe
• Sekunder – Riwayat masuk
– TTV lengkap – Riwayat yang lalu
– GCS – Pelibatan keluarga
– Trauma score – Gips/bidai dll
 Manifestasi Clinis
1. Oedema and swelling
2. Pain and tenderness
3. Muscle spasm Waspadai 5P: ischemia
4. Deformity 1. Paraesthesia/
numbness
5. Echymosis 2. Pain
3. Pallor
6. Loss of function 4. pulselessness
5. paralysis
7. Crepitation
 Katagori klien & transfer
Emergency Dept. Trauma Center
• Contussion • Brain injury
• Back sprain • Paralysis
• Fractured rib • Pneumothorax
• Fractured femur • Multiple fractures
• Laceration • Stab wound
Prioritas asuhan
1. Cegah cedera lanjutan
2. Mengatasi nyeri
3. Cegah komplikasi
4. Memberikan informasi: kondisi, prognosis,
perawatan

“restore and preserve function”

Discharge/pemulangan
1. Prioritas Pemulangan:
2. Fraktur stabil
3. Nyeri terkontrol
4. Komplikasi: tidak/minimal
5. Pemahaman klien meningkat
6. Ada rencana yang jelas
Nursing Diagnosis
• Resiko cedera
• Nyeri
• Resiko gangguan neurovaskular perifer
• Kerusaka mobilitas
• Resiko infeksi
• Cemas
 Intervensi
Points:
• Positioning Pelajari
• Cast Care: Wet Secara mandiri

• Traction/Immobilization Care Buku2 khusus

• Pain Management KMB/Orto
• Circulatory Precautions
• Circulatory Care: Arterial [or] Venous
Insufficiency
• Pressure Management
 Intervensi
Beware:
Points:
Shock prevention
• Bed Rest Care and management
• Skin Surveillance - Resuscitation
• Traction/Immobilization - Skeletal
• Infection Prevention Stabilization
- Bleeding control
• Teaching: Disease
Process
 RICE (ENA, 2014) in emergency
• Rest the affected joint, no weight bearing, and avoid
use. Perform range of motion four times a day as soon
as recommended.
• Ice. The general rule is to apply ice for 20 minutes at a
time, four times a day for the first 24 hours to promote
vasoconstriction and reduce swelling.
• Compression with an elastic bandage is recommended
to help reduce swelling and provide support. The
elastic bandage should be rewrapped twice a day and
removed at night.
• Elevation above the level of the heart the first 24 hours
after an injury is recommended to reduce swelling.
 Flail chest, pneumothorax, tension
pneumothorax à chest drains
• Masalah tatalaksana fraktur sama. Fiksasi. Prinsip
utama: Pain management, Positioning, Coughing,
Deep breathing
• Gejala Utamanya merupakan masalah pernafasan
yang diakibat nyeri à tertusuk fragment tulang
• Pneumothorax, tension pneumothorax
• Harus dipasang Water seal drainage (WSD) untuk
re-ekspansi pengembangan paru yang kolaps
Stabilization Management External-Fixation

Cast

Arm sling
 Pathophysiology of
Spinal Cord Injury
The higher up the injuries occurs,
the worst the symptoms

Cervical à life threatening:

arms, legs, breathing
Thoracic à legs, pelvic organs
Lumbar à legs, incontinence

Tetraplegia: paralysis on both of

arm and leg
Paraplegia: paralysis of the leg
 External fixation devices
• Allow serous drainage to flow
• Avoid using a thick layer of antimicrobial ointment at the
pin insertion site and do not use occlusive dressings
• Crust formation at the skin-pin junction site should be
removed gently
• Notify the healthcare provider if any skin tension develops
at the skin-pin insertion site
• Avoid local tissue trauma at the skin-pin insert site
• Use antiseptic solutions based on individualized needs
• Lubricate pin traction junctions and avoid stress and strain
on the fixator
(Ohio State University Medical Center, 2008)
Skeletal Traction

Skin traction
 Hospital Clinical guidelines
• https://www.rch.org.au/rchcpg/hospital_clinical_
guideline_index/Skin_traction/

• https://www.schn.health.nsw.gov.au/_policies/p
df/2014-9099.pdf

• Penting untuk dipelajari hal2 spesifik

• Jangan hanya belajar NANDA, NIC, NOC atau 3S
saja
Thanks
Have a nice “at home study”
terimakasih

Klik link berikut untuk mengikuti POST TEST

https://www.surveymonkey.com/r/KGDmas