Distraction Plate Fixation Post-Procedure Essay Example for Free

Distraction Plate Fixation Post-Procedure Essay Type III compression injuries o Require operative treatment if ? Intraarticular damage is significant ? Radial shortening is severe o Fixation with multiple Kirschner wires or plates is often necessary, and cancellous bone grafting is frequently required to fill impacted areas. Often a combination of open and closed techniques is necessary to satisfactorily treat type III fractures. Type IV avulsion fractures o Are usually associated with radiocarpal fracture-dislocations and are therefore unstable o Often the avulsed fracture fragments are so small that they can be repaired only with suture. o Secure reduction of the carpus to the distal radius can frequently be achieved only with Kirschner wires. Type V high-velocity fractures o Always unstable, frequently open, and difficult to treat o A combination of percutaneous pinning and external fixation is often necessary. Many of these fractures are so severely comminuted that open reduction is impossible. †¢ CONTRAINDICATIONS Severe medical comorbidities that prevent surgery EQUIPMENT †¢ †¢ †¢ Hand tray and hand table Small fragment and mini fragment set Technique-specific tray, as required ANATOMY †¢ The distal radius and ulna may be divided into three distinct columns. o The lateral and medial columns correspond to the scaphoid facet and lunate facets, respectively, of the distal radius. o The medial column is further divided into dorsomedial and volar medial parts. The ulnar column consists of the ulnar styloid and triangular fibrocartilage complex. ? ? Tears of the triangular fibrocartilage occur when the medial column of the distal radius, ulnar styloid, or both are intact. Distal radioulnar joint instability is associated with significant displacement of the ulnar styloid. TECHNIQUES †¢ †¢ †¢ Post-Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) Post-Procedure: Distraction Plate Fixation POST-PROCEDURE CARE †¢ †¢ †¢ †¢ †¢ Immediately begin finger and other joint upper extremity exercises. If a splint was applied, it should be removed at 3 weeks. Percutaneous Kirschner wires should be removed at 6 weeks. Activities of daily living are allowed, but lifting should be restricted to 5 lb. Once union is achieved, remove the distraction plate and begin range-of-motion exercises. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for distraction plate fixation. OUTCOMES AND EVIDENCE Ruch et al reported good to excellent outcomes in 90% of 22 patients using this technique. Procedure: Distraction Plate Fixation Post-Procedure: Volar Buttress Plate Fixation (Ellis) POST-PROCEDURE CARE †¢ Immobilize the wrist and forearm with a plaster sugar tong splint for 2 weeks. †¢ †¢ Next, use a removable ball-peen splint, permitting gentle active exercises two or three times a day for the next 2 weeks. All immobilization is removed at 4 weeks and progressive motion continued until union is solid. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS The use of buttress plating for the treatment of distal radius fractures have proven to yield excellent results when surgical intervention occurs early and care is used to obtain anatomic reduction of the fracture. OUTCOMES AND EVIDENCE †¢ †¢ Smith et al: 100% union rate with 71% excellent, 18% good, and 11% fair results. Odumala et al: No difference in development of median nerve symptoms in patients treated with prophylactic carpal tunnel decompression compared with those without decompression. Procedure: Volar Buttress Plate Fixation (Ellis) Post-Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) POST-PROCEDURE CARE †¢ †¢ †¢ †¢ Keep the extremity elevated at all times until postoperative swelling subsides. Beginning on the first postoperative day, remove the splint 2 to 3 times a day for rangeof- motion exercises. Allow clerical work at 2 weeks. Resistive loading is allowed when signs of radiographic union appear. COMPLICATIONS †¢ †¢ †¢ †¢ †¢ Median nerve injury Reflex sympathetic dystrophy Malunion, nonunion Tendon rupture Infection ANALYSIS OF RESULTS Studies have demonstrated a high percentage of good to excellent outcomes for the Medoff system. OUTCOMES AND EVIDENCE Medoff reported 20 good to excellent results in 21 patients with intraarticular comminuted distal radial fractures treated with the TriMed Wrist Fixation System (TriMed, Valencia, Calif. ). Procedure: Volar Plating of Intraarticular Compression Injuries (Medoff) PRE-OPERATIVE AND POST OPERATIVE CARE Care of Pre-operative Patient Nursing Diagnosis Knowledge deficit R/T pre-op care. Expected Outcome Patient/parent will verbalize understanding of pre- post-op care. Nursing Intervention 1. Implement pre- post-op teaching program. 2. Document response. 1. Remove nail polish, make-up. 2. Bathe and shampoo the night before surgery. 3. Betadine scrub to surgical area. 4. Dress in hospital clothing after scrub. 1. NPO as ordered. 2. Sign at bedside; NPO sticker on patient. Potential aspiration R/T general No aspiration. anesthesia. 3. Re-emphasize importance of NPO to patient and parent; empty water pitcher and glass from bedside; check crib for bottles. 1. Explain procedures. 2. Provide time for patient/parent to ask questions, express fears or concerns. . Offer reassurance. Potential alteration of vital functions R/T surgery. Normal parameters for patients vital signs established. 1. Obtain baseline assessment of all systems ; N/V status within 8 hours pre-op. Potential infection R/T surgical procedure. Infection free post-op. Potential anxiety R/T surgery. Decreased anxiety. 2. Assess V. S. within 2 hours pre-op. Care of Post-operative Patient Nu rsing Diagnosis Knowledge deficit R/T post-operative care. Expected Outcome Patient and family will verbalize and demonstrate understanding of postoperative care. Patient and family will cope effectively with surgical postoperative process. Nursing Intervention 1. Implement post-operative teaching program. 2. Document response. 1. Explain procedures. 2. Provide time for questions, expression of concerns and fears. 3. Offer reassurance. Potential anxiety R/T surgery, post-operative care. Potential respiratory Patient will not experience compromise R/T general respiratory compromise. anesthesia. 1. Assess breath sounds-HR/RR at least q shift. 2. Turn, cough and deep breathe q2 hrs. 3. Record vital signs. Patient will Alteration in comfort R/T verbalize/demonstrate relief surgery. rom pain. Potential neurovascular Patient will not experience compromise R/T surgical neurovascular compromise procedure. . 1. Assess for pain and medicate per protocol. 2. Reposition for comfort as ordered/prn. 1. Assess surgical site or affected extremity for color, capillary refill, sensation, temperature, pulses and active/passive ROM as ordered. 2. Document neurova scular status as ordered. 3. Report any neurovascular compromise to M. D. 4. Position extremity with elevation if ordered. 5. Apply ice or heat as ordered. Potential alteration in level of consciousness R/T anesthesia. Patient will exhibit appropriate LOC. 1. Assess LOC q shift. 1. Monitor I/O q hour with IV or foley. 2. Begin ice chips or clear liquids slowly as ordered. 3. Maintain IV fluids as ordered. 4. Call M. D. for catheter order if unable to void after surgery. 5. Assess GU status q shift. Potential alteration in bowel elimination R/T Patient will have BM by postanesthesia and postoperative day #4. operative immobilization Potential alteration in skin integrity R/T immobility. Patient will not experience skin breakdown. 1. Mobilize as ordered. 2. Administer laxative of choice or suppository for no BM after 3 days. . Assess GI status q shift. 1. Assess skin q shift. 2. Provide daily nursing care. Potential alteration in fluid balance R/T surgery. Patient will have adequate fluid intake and urine output. Medical Diagnoses: Impaired Physical Mobility, Acute pain, secondary to fractured left femur, ORIF surgery, Musculosketeal impairment Assessme Nursing Client Nursing *I Evaluation nt DX/Clin ical Goals/Desired Interventions/Actions/ Goals Interventio Problem Outcomes/Object Orders and Rationale ns ives Subjectiv Problem: Long Term: * Apply any ordered X Goal met. Continue e brace before Pt was intervention Impaired Pt will be able to mobilizing the client. able to s as listed. Pt Physical ambulate around ambulate Encourage screams Mobility the nurses’ Rationale: around pt to when station 2X by â€Å"Brace support and the continue the staff discharge. stablilize a body part, nurses’ use of attempts allowing increased station by braces and to move mobility. † (Ackley ; discharge. assistive the left Ladwig, 2008, p 552). Pt was devices lower able to after extremity *Increase complete discharge Pt demonstr ates difficulty with any movemen t of the left lower extremity . independence in ADLs Rationale: â€Å"Providing unnecessary assistance with transfers and activities may promote dependence and a loss of mobility. † (Ackley ; Ladwig, 2008, p 552). *Obtain any assistive devices needed for activity. Rationale: â€Å"Assistive devices can help increase mobility. † (Ackley ; Ladwig, 2008, p 552). R/T: Short Term: O bjective Pt states that his pain level is a 9 on a 10 point pain rating scale. is activity until he more than feels twice. Pt comfortable did not c/o. complain Encourage of any the pt to pain or continue his discomfort independen upon ce in ADLs ambulatio and c/o n. unnecessary assistance. Pt states â€Å"I feel like I’m finally getting back to my old self. † X Goal met. Pt able to fully complete passive range of motion exercises with assistance from the staff by the end of this shift. Pt did not complain of any pain associated with exercise session. Continue intervention s as listed. Continue to assess pain using the 10 point pain scale q4 hrs or PRN. Continue to provide pain control and treat as needed. *Assess the pt’s pain Acute Pt will perform by using the 10 point pain, passive range of pain rating scale q4 hrs secondary motion exercises or PRN. to by the end of this fractured shift. Rationale: left femur â€Å"Single- item ratings of Pt pain intensity are valid grimaces ORIF and reliable as during surgery measures of pain any kind intensity. of motion Anxiety or â€Å"The client’s report of movemen Musculosk pain is the single most t of his eteal reliable indicator of left lower impairmen pain. † extremity t (Ackley ; Ladwig, 2008, p. 604-605). AEB Pt’s ORIF *Before activity, treat Grimacing surgery pain. during movement Rationale: or activity â€Å"Pain limits mobility and is often Pt complaints about pain and discomfort Pt pain rating of 9 out of 10. Surgery that is 2 days postop exacerbated by movement. † (Ackley ; Ladwig, 2008, p 552).

Andy Warhol Essay -- essays research papers

Andy Warhol Never before have I encountered more intriguing works of art than those done by Andy Warhol. I have been curious about his life ever since I saw his work in Milwaukee. I saw his famous work of the Campbell's Soup Can. By viewing this, one can tell he is not your average artist. I'm sure his life is full of interesting events that shaped him into who he was. As an artist myself, I would like to get to know the background of his life. I may then be able to appreciate his styles and understand why and how his works were created. His life is as interesting as his artistic masterpieces. Andrew Warhola (his original name) was born one of three sons of Czech immigrants, somewhere in Pennsylvania on either August 6, 1928 or on September 28, 1930 (the date on his birth certificate). His father died when Andy was at a very young age. Thus, it forced Andy into a deep depression containing lack of self confidence. Much of his young life has been kept secret. However, he did report being very shy and depressed because he never felt comfortable with his homosexuality. His childhood life may have been full of the torture that children threw at him for being the different person he was. He was able to attend college. After graduating with a Bachelor of Arts degree in pictorial design from Carnegie Institute of Technology in 1949, he went to New York City with Philip Pearlstein, who was a fellow student that later became a well-known realist painter. In 1960, Warhol finally began to paint in earnest and to view art seriously as a career. He began his career with commercial drawings of women's shoes. In 1961, an early manifestation was his Dick Tracy, an enlarged version of the comic strip that was placed in the window of Lord & Taylor's department store. He followed in his own footsteps to keep going in the ever-so-famous "pop art" track. Warhol's use of images are so close to the images themselves, thanks to the photographic silkscreen technique, which is a process of applying the same image over and over again without changing the original. In 1963, he began turning film into his next aesthetic. He was the recorder of the world around him. Warhol saw this world as populated by hustlers of various sorts, motivated largely by money and the goods it would buy. Later that next year, he started to experiment in underground film. In the late 70's he ... ...Amis 1732). Others saw the diaries as a simplistic record of events. "His diaries are more or less just records of who went where and did what with whom, that anybody else who'd been along could have kept" (Plagens 1732). It's too bad he didn't start the diaries earlier in his life, such as the 60's, "when it would have been more interesting to know what he did and whom he was with, instead of waiting until 1976 to begin" (Plagens 1732). Some even complained of the editing job done by Pat Hackett. "One problem with the diaries is their postmodern polish, such as the casual proofreading and editing" (Trebay 1732). The reason the editor didn't fit up to par was the mere fact she wanted it to sound how Andy explained the day. "...still the book is great social history with its lip-smacking tales of loveless, sexless marriages, its gimlet-eyed view of other people's success, and its rampant unclosetings" (Trebay 1732). I, myself, found the book very entertaining and a great nonchalant look at the famous and their everyday lives. It may have been organized better and condensed a bit, but none-the-less it was still interesting and kept me reading.

Roman Empire and Nero

Explain the role and contribution of Seneca to the reign of Nero Seneca was the personal advisor of Nero during his reign. He was a stoic philosopher who played a vital role in the running of the empire. Seneca contributed in many aspects of Nero’s reign by introducing reforms, bringing stoicism into practice and playing a key role in the senate. Seneca aided in important decision-making. He led Nero down an appropriate path, particularly when Nero became extremely erratic. He served Nero well and made an excellent contribution during his reign.Seneca understood the problems of Rome so he was able to introduce reforms, which benefited the people. He made conditions for slaves more humane, introduced fiscal reform and introduced a more enlightened administration in Britain. This positively contributed to the empire as he had the happiness of the people in his best interest. By introducing reforms that pleased the people he gained popularity for both himself and Nero. This was b eneficial for Nero as the people of the empire could look back on Nero’s reign years later and reflect on the good decisions and excellent reforms that had taken place during the period.Tacitus says â€Å"Nothing in human affairs is more unstable and precarious than power unsupported by its own strength. † This quote by Tacitus shows us just how great the impact of Seneca was. It is telling us that without Seneca, Nero may have had the power, but had no support to advice him to make the correct decisions. Seneca was the strength to Nero’s power. Seneca composed Nero’s first speech to the senate. This speech offered additional power to the senate and shows that Seneca was contributing to the reign of Nero right from the very start.The speech also promised to return to what life had been like under Augustus. Of course, the empire was considered a Republic during the Augustan period and the people cherished this time. Seneca and Nero were looked upon favoura bly when they promised to return to a time of happiness. Therefore Seneca helped encourage an excellent start to the reign of Nero. Stoicism influenced the writing of Seneca for Nero as he wrote â€Å"on clemency† which encouraged Nero to rule leniently. Stoicism is particularly shown as he writes â€Å"†¦worthy to do the ork of the gods upon the earth† It is known that the Roman’s were very religious, so to do the work of the gods would be seen as ethically and morally right to Seneca. These traits are one of the beliefs of Stoicism, reflecting his influence. This contributed to Nero’s reign as it meant that Nero came across as a self-controlled, morally right stoic man who would run the empire leniently and satisfy the people of Rome. Satisfied Romans meant that they would continue to give their support to Nero during his reign. Seneca worked efficiently with the senate allowing Nero to remain popular within the senate.A key role that Seneca played was to ensure that the Neronian government had good relations with the senate. He did this very effectively. This was an excellent contribution to his reign as it allowed Nero to remain popular within the senate, as well as with the people. Remaining popular among Rome meant that he had the support of its people and could continue to rule effectively with Seneca by his side. Seneca’s influence was particularly shown as he wrote the speech Nero gave where he declared his administration for the senate and his desire that they resume their ancient function.Seneca’s successful speeches helped contribute to the healthy relationship between Nero and the senate as he told them what they wanted to hear. He also issues coins, which were a further indicator of the good relations between Nero and the senate. Credit for this successful relationship must go to Seneca who put the words into Nero’s mouth and was able to satisfy the senate by giving them what they wanted. A co operating senate meant that the empire was able to run much better during Nero’s reign.Further on in Nero’s reign, Seneca began to see a change. He grew more erratic and extreme. From here it became the role of Seneca to curb his enthusiasm. Tacitus describes this job as â€Å"To direct his deviations from virtue into licensed channels of indulgence. † The shows that Seneca fulfilled his job by avoiding activities that would result in scandal. Nero’s frustration grew out of many of his liberal ideas failing and it was the role of Seneca to alert Nero about his policies if they were ineffective or bad policy.Although Seneca was unable to change the personality of Nero and his behaviour, he was able to contribute to the outcome of his actions. Seneca benefited the empire by avoiding decisions, which would consequence in revealing Nero’s awful erratic side. This benefited the empire in that Nero was still able to be favoured as the Romans did not see the worst of his erratic and extreme personality, as well as stopping Nero from making rash decisions that would not help his reign by informing him when policies or ideas were not recommended.Seneca’s contribution was beneficial for all aspects of Nero’s reign. He was able to advise Nero on important decision-making and was able to put a stop to Nero introducing policies and ideas that would not benefit his reign. Seneca provided a voice for Nero and was able to tell the Roman people wanted to hear and in turn earned their support. Seneca’s introduction of new policies and creating of stoicism contributed further to increasing the success of the empire, as well as the success of Nero.Seneca provided the strength to Nero’s power and without his contribution the reign of Nero would not have been as delightful. Seneca was able to make people dream of a â€Å"Republic† which further forced their support onto Nero. He also played a role in creating and maintaining a healthy relationship with the senate so that through Nero’s reign they were able to run the empire in collaboration. The role and contribution of Seneca was vital to the success of Nero, he acted as an excellent advisor to the emperor, particularly through giving a stoic voice to Nero.

Gender Discrimination - 1008 Words

Gender-bias within the workplace has existed as long as both males and females have worked together, and even now, it is a prevalent issue in modern society. Discrimination classified as gender-bias is the unequal treatment or employment due to the gender of an individual. While U.S. Code Title 42, Chapter 21, 2000e-2 prohibits discrimination based on gender, religion, age, disability, race, and national origin (Cornell), illegal and unfair employment practices still affect many people. Despite several laws prohibiting bias in the workplace, it still occurs, in starting positions and throughout leadership. Gender-bias results in unequal treatment among genders and persists the outdated notion that gender is a qualification for knowledge†¦show more content†¦Another study, by Shefali Patil, showed that forcing gender-equality resulted in increased gender discrimination due to resentment, thus gender-bias transpires, but has nuances. Dr. Janet Shibley Hyde, a psychologist fr om the University of Wisconsin, concluded from her observation of dozens of studies, generally workplace studies reveal women who deviate from the caring, nurturing female stereotype are perceived less favorable when being hired or evaluated. Employees often need to cooperate amongst themselves and other businesses, however, males negotiating with males tended to have the lowest levels of initial trust, showing a prejudice towards the same gender (Sung, et al., 2008). In another study, it is suggested that gender discrimination in human resource related decisions stems from gender inequalities in broader organizational structures. Discriminatory human resource policies are created by both hostile (intentionally hindering a person) and benevolent (harming a person by overly protecting them) sexism (Stamarski and Hing, 2015). Several factors can alter gender stereotypes, such as race, religion, gender, and age. For instance, a study found 33% of female students expected a womanâ€℠¢s gender to affect her pay; but less than 20% of male students agreed. Similarly, it was found women were more likely to anticipate gender discrimination than males. It was also found that college-aged students generallyShow MoreRelatedRacial Discrimination And Gender Discrimination962 Words   |  4 Pagesincreasingly being seen, especially on social media. It s a single word which people are using instead of the longer phrases disability discrimination or disability prejudice. Racial discrimination and gender discrimination have their own single words - racism and sexism - and so those ideas can be expressed a little more easily. Disability discrimination is often complicated and misunderstood. At one end of the scale, buildings with steps instead of ramps may be said to be ableist. 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