Info

General Comments: Surgeons may choose to follow cultures of wounds, urine, blood, and sputum, rather than use prophylactic antibiotics. A tetanus booster may be administered to patients, depending on their history.

Medication or Drug Class

Dosage

Description Rationale

Narcotic analgesics

Varies with drug but generally given IV in the early phases

Morphine sulfate, fentanyl, Provide relief of pain meperidine

Other Drugs: Antibiotics such as gentamicin, ampicillin, vancomycin, metronidazole

Independent

Maintain the patient in a supine position if it is not contraindicated because of other injuries. Ensure adequate airway and breathing in this position. Because Trendelenburg's position may have negative hemodynamic consequences, may increase the risk of aspiration, and may interfere with pulmonary excursion, it is not recommended. If the PASG has been applied to stabilize the bony fractures and tamponade bleeding, protect the extremities with towels.

Pelvic Inflammatory Disease 705

Wound care varies, depending on the severity of wounds, the presence of an open fracture, and the type of fixation device applied. Initial debridement may be done in the operating room at the time of the exploratory laparotomy. Wounds and any exposed soft tissue and bone are covered with wet sterile saline dressings. Avoid povidone-iodine (Betadine)-soaked dressings to limit iodine absorption and skin irritation. Use universal precautions to avoid exposing patients to infection.

Extensive periods of bedrest increase the risk of complications. Remove devices every shift to assess the underlying skin and provide skin care. Sequential compression devices may be applied to the upper extremities if the lower extremities are fractured or in skeletal traction. Provide active or passive range-of-motion exercises to uninjured extremities every shift, as appropriate. Maintain traction by keeping it free-hanging; do not remove weights when moving or repositioning the patient. Some patients may benefit from the use of specialty beds, such as a rotating bed that may improve pulmonary status while maintaining bony stability. Do not use external fixation devices to move or turn patients. Maintain skin integrity by using specialty mattresses with pressure-releasing components. Protect the patient from injury by covering all wire ends with plastic tips, corks, or gauze. When positioning the patient with an external fixation device, protect the skin with padding. Keep the patient's skin clean and dry. Gently massage the patient's bony prominences every 4 hours.

• Physical findings: Vital signs, urine output, body weight, capillary refill, mental status, quality of peripheral pulses, urethral bleeding, bowel sounds, wound healing, bruising

• Response to bedrest and immobility, position of external fixation device, degree of range of motion, progress toward rehabilitation

• Presence of complications: Infection; pressure sores; inadvertent injury from external fixation devices, hemorrhages

• Pain: Location, duration, precipitating factors, responses to interventions

To prevent complications of prolonged immobility, encourage the patient to participate in physical and occupational therapy as prescribed. If compression stockings are prescribed, teach the patient or family the correct application. Verify that the patient has demonstrated safe use of assistive devices such as wheelchairs, crutches, walkers, and transfers. Teach the patient the purpose, dosage, schedule, precautions, and potential side effects, interactions, and adverse reactions of all prescribed medications. Review with the patient all follow-up appointments that are arranged. If home care is necessary, verify that appropriate arrangements have been completed.

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