CH 62 - Common Joint Surgical Procedures
When caring for patients who undergo a total hip arthroplasty (THA), the nurse recalls that prophylactic anticoagulant drugs are given for at least how many days postoperatively? 3 to 5 days 7 to 10 days 10 to 14 days 45 to 60 days
10 to 14 days Prophylactic anticoagulant drugs should be given for at least 10 to 14 days postoperatively, following a THA.
The nurse provides postoperative care following a patient's total hip replacement surgery. Which nursing action indicates an effective intervention? Allow the patient to sit on chairs without arms. Allow the patient to cross legs at the knees or ankles. Allow the patient to perform daily activities, for example, putting on shoes and socks. Allow the patient to use a pillow between the legs for the first six weeks after surgery.
Allow the patient to use a pillow between the legs for the first six weeks after surgery. The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90 degrees, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90 degrees will lead to damage of the soft tissue. Therefore it should be avoided until at least six weeks after the surgery.
The nurse reviews the plan of care for a patient and notes that an osteotomy is scheduled to treat which condition? Synovitis Amyotrophic lateral sclerosis (ALS) Rheumatoid arthritis Ankylosing spondylitis
Ankylosing spondylitis An osteotomy involves removing a wedge or slice of bone to change alignment and to shift weight bearing, correcting a deformity. A patient with ankylosing spondylitis may benefit the most from an osteotomy because it corrects the deformity in the patient. Synovitis is the inflammation of the synovial membrane and is corrected through synovectomy. ALS and rheumatoid arthritis are not treated with osteotomy.
The nurse provides postoperative care for a patient following shoulder surgery. The nurse assists the patient with physical therapy exercises to prevent which complication? Arthrofibrosis Fat embolism Thromboembolism Compartment syndrome
Arthrofibrosis Arthrofibrosis of the shoulder capsule, can be prevented by physical therapy after the surgery. Drug therapy is a management technique for fat embolism. Anticoagulants are used as both prevention and treatment for thromboembolism. Compartment syndrome can be prevented through proper assessment techniques and rapid surgical intervention.
The nurse provides information to a nursing student about hand surgery. When asked about the primary goals of hand surgery, which statement made by the student indicates the need for further teaching? "A primary goal is to strengthen the hand joint." "A primary goal is to restore the ability to grasp." "A primary goal is to restore the stability of the hand." "A primary goal is to correct the deformity of the hand."
"A primary goal is to correct the deformity of the hand." The goal of hand surgery is primarily to restore function related to grasp, pinch, stability, and strength, rather than to correct cosmetic deformity.
The nurse is completing an admission history for a patient with osteoarthritis who has been admitted for a knee arthroplasty. When the nurse asks the patient why the procedure is being performed, which does the nurse anticipate the patient will state? "I have chronic knee pain." "I have a fractured patella." "I have frequent and multiple falls." "My knee needs to be totally immobilized."
"I have chronic knee pain." The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. A fractured patella would be the result of a fall or trauma, not osteoarthritis. Frequent and multiple falls are not associated with osteoarthritis, and although pain is chronic, the knee will not be completely immobilized.
Which postoperative care is included in the nursing care plan of a patient who undergoes a finger joint arthroplasty? Restricted use of nonsteroidal antiinflammatory drugs (NSAIDs) to decrease the risk of bleeding Hand splint for five days to protect the surgical site from injury Hand exercises for 10 to 12 weeks Hand exercises two times a day
Hand exercises for 10 to 12 weeks After surgery, the patient is discharged with splints to use while sleeping and hand exercises to do at least three or four times a day for 10 to 12 weeks. NSAIDs are often helpful to decrease pain, especially when used prophylactically before therapy sessions; there is no information provided to indicate a need to restrict their use.
The nurse provides education for a group of nursing students about the osteotomy procedure to relieve joint pain and includes which information? It may be used to correct a kyphotic deformity in patients with ankylosing spondylitis. The procedure includes the removal of debris, such as loose bodies or osteophytes, from a joint. It is effective in patients with inflammatory joint disease. It involves the reconstruction of a joint to relieve pain, improve or maintain range of motion (ROM), and correct deformity.
It may be used to correct a kyphotic deformity in patients with ankylosing spondylitis. An osteotomy involves removing a wedge or slice of bone to restore alignment (joint and vertebral) and to shift weight bearing, thus relieving pain. Cervical osteotomy may be used to correct a kyphotic deformity in patients with ankylosing spondylitis. Debridement is the procedure that is the removal of debris, such as loose bodies or osteophytes, from a joint. Osteotomy is not effective in patients with inflammatory joint disease. Arthroplasty is the reconstruction of a joint to relieve pain, improve or maintain ROM, and correct deformity.
The nurse discusses a patient's debridement of a shoulder with a nursing student. The nurse explains that debridement involves the removal of which items from the joint? Select all that apply. Joint debris Osteophytes A wedge of bone Synovial membrane Pieces of cartilage
Joint debris Osteophytes Pieces of cartilage Debridement is the removal of debris, such as pieces of bone or cartilage (loose bodies) or osteophytes, from a joint using a fiberoptic arthroscope. This procedure is usually done on an outpatient basis on the knee or shoulder. The removal of a wedge of bone is called osteotomy. Removal of synovial fluid is called a synovectomy.
A patient with osteoarthritis is scheduled for a total left knee arthroplasty. The nurse assesses the patient carefully preoperatively to verify that there is no evidence of which condition? Chronic pain Left knee stiffness Left knee infection Left knee instability
Left knee infection It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count. Chronic pain, knee stiffness, or instability may be present with osteoarthritis and is not a reason to postpone arthroplasty.
A patient with osteoarthritis (OA) who experiences consistent knee pain undergoes an osteotomy. Which is an expected finding during the postoperative period? Relief from pain Decreased mobility Free movement of the joint Deformity correction of the joint
Relief from pain When an osteotomy is performed on a patient with osteoarthritis, surgery provides relief from the pain. Mobility is improved after the surgery. A joint cannot be moved as freely after surgery as compared to before the surgery. Deformity can be corrected with a replacement surgery.
Which type of surgical repair is performed during hemiarthroplasty? Reshaping of the femoral head Repairing with internal fixation devices Replacing both femur and acetabulum Replacing part of the femur with prosthesis
Replacing part of the femur with prosthesis Hemiarthroplasty is a surgical replacement of part of a joint. Replacement of part of the femur with a prosthesis is known as hemiarthroplasty. Reshaping of the femoral head is done during hip resurfacing in which the femoral head is reshaped rather than replaced. Repairing the joints with internal fixation is done through devices such as pins, plates, and intramedullary rods that are inserted into the joint to attain the correct bone alignment. Replacing both femur and acetabulum is performed during a total hip arthroplasty.
The nurse provides education for a group of nursing students about the removal of osteophytes from a shoulder joint and includes which information? The surgical procedure is done in an outpatient setting. Activity is restricted for 72 hours after the surgical procedure. Passive flexion exercises with a continuous passive motion are recommended. The patient should perform an isometric muscle-strengthening exercises within the confines of an immobilization device.
The surgical procedure is done in an outpatient setting. Debridement is the removal of debris, such as pieces of bone or cartilage (loose bodies) or osteophytes, from a joint using a fiberoptic arthroscope. This procedure is usually done on an outpatient basis on the knee or shoulder. A compression dressing is applied after surgery. Weight bearing is permitted after knee arthroscopy. Patient teaching includes monitoring for signs of infection, managing pain, and restricting activity for 24 to 48 hours.
Which joint is a common site for surgical fusions? Hip joint Knee joint Wrist joint Elbow joint
Wrist joint Arthrodesis is the surgical fusion of a joint. Common areas of joint fusions are the wrist, ankle, and cervical spine. The hip, knee, and elbow joints are not considered ideal sites for surgical fusion, because fusion of those joints will lead to immobility.
The nurse is teaching a nursing student about the common sites for a synovectomy. Which understanding about the surgical sites by the student indicates effective learning? Select all that apply. Hip joint Ankle joint Wrist joint Finger joint Elbow joint
Wrist joint Finger joint Elbow joint Common sites for synovectomy are the wrist, fingers, and elbow joints. Synovectomy is the surgical removal of the synovium (the membrane that lines the joint), which is performed to relieve pain and improve range of motion for patients suffering with rheumatoid arthritis. The hip and ankle joints are not common sites for synovectomy. Hip arthroplasty (joint replacement) and hip resurfacing are usually performed at the hip joint. Ankle arthrodesis (joint fusion) and arthroplasty are performed at the ankle joint.