Ortho
The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed?
"Under no circumstances should I get my cast wet."
simple fracture
(closed) bone is broken but does not break through the skin
plaster cast care
- May take 24-72 hours to dry - Don't touch when wet - Keep dry - Heavy
normal lab value for Phosphorus (Phos)
2.5-4.5 mg/dL
normal lab value for Alkaline Phosphatase
42-136 U/L
Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?
Acute respiratory distress syndrome
osteoarthritis is the same as what
DJD (degenerative joint disease)
Longitudinal Fracture
Fracture line extends across the long axis of the bone.
sprain
Ligament injury. Ligaments bind bones together.
Ketorlac and Aspirin drug class
NSAIDs
amputation of a lower extremity can be due to (4) & the goal is ?
The surgical removal of a lower limb or part of the limb - Due to trauma, infection, frostbite or vascular disease - Surgery performed above the level of healthy tissue. Goal: PRESERVE FUNCTION!!
displaced fracture
a break in which the bone ends are out of normal alignment
Synarthrosis joints are
immovable joints
what is antidote for heparin
protamine sulfate
compound fracture
(open) bone is broken and a fragment of bone protrudes through an open wound in the skin
A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply. (4)
- "I cannot seem to catch my breath." - "I have a pins-and-needles sensation in my toes." - Dorsoplantar weak and unequal bilaterally - T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%
A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply. (3)
- "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." - "Fractured bones require a good blood supply and adequate nutrition for healing." - "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."
A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply. (2)
- Advise the client to use a trochanter roll. - Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.
A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. (3)
- Assess the fingers for color and temperature. - Assess for a pressure sore - Determine the exact site of the pain.
usually planned procedure (3)
- Autologous Blood Transfusions (donated by yourself months prior to surgery in case needed during) - Joint Camp (patients meet in groups with everyone they need after surgery) - Post Discharge Care
medical management for hip fractures (3)
- Bucks Extension Traction - Surgical Treatment which is carried out as soon as possible after injury - ORIF, performed within 12-24 hours. Displaced femoral neck fractures are treated as emergencies.
A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? Select all that apply. (3)
- Deep vein thrombosis - Compartment syndrome - Fat embolism
COMPLICATIONS OF FRACTURES : Delayed Complications (5)
- Delayed union & nonunion - Avascular necrosis - reaction to internal fixation devices - complex regional pain syndrome - heterotopic ossification.
knee replacement post-op care (7) and should ambulate when ?
- Drains removed POD#2 - CPM (Continuous Passive Motion) - ICE Chest - PCA pump - SCD (Sequential Compression Device) so they don't get blood clots - Foley - Antibiotics - Ambulate 1st day
Fiberglass cast care
- Dries quickly - Water resistant - Light weight - Strong
Anti Coagulants
- Enoxaparin is used for DVT prevention - Heparin is used to treat thrombus (blood clots) - Warfarin is oral medication for ongoing treatment or prevention KNOW THE REVERSAL AGENTS !!
Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. (3)
- Ensure the pins or wires are covered with caps. - Position trapeze within the client's reach. - Instruct the client on isometric exercises for immobilized extremity.
observe stump for
- Excessive Swelling - Hemorrhage: Hold pressure & May require tourniquet if persists - Infection - Drainage - Odor - Erythema - Edema
COMPLICATIONS OF FRACTURES : Early Complications (6)
- Fat embolism - Compartment syndrome - Deep Vein Thrombosis - Thromboembolism - Disseminated Intravascular Coagulopathy - Infection and osteomyelitis
hip arthroplasty: post-opcare (7)
- HOB should not be elevated > 60 degrees for first few days - When sitting up, hip should not be flexed>90 degrees• Position leg in abduction - Avoid rotation of hip joint (internal &external rotation) - Abduction (wedge) pillow maintains proper alignment - Length of immobility depends on surgeon - Pt stands & pivots on unaffected side with assistance - Ambulation within 48 hours
A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply. (3)
- Handle the cast with the palms of hands - Circulate room air with a portable fan - Petal and smooth the edges of the cast
2 types of hips fractures
- Intracapsular - Extracapsular
Which statements describe open reduction of a fracture? Select all that apply. (3)
- It is performed in the operating room. - The bone is surgically exposed and realigned. - The client usually receives general or spinal anesthetic.
A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply. (4)
- Magnetic resonance imaging (MRI) - Ultrasound - X-ray - Computed tomography (CT)
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. (3)
- Muscle spasms will be relieved. - The bones of the left leg will be aligned. - Immobilization of the left leg will be maintained.
Ibuprofen drug class ? causes chance of ? take with ?
- NSAID/Analgesic - Increased chance of GI bleed - Take with food to decrease upset stomach
A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply. (4)
- Pneumonia - Skin breakdown - Sepsis - Delirium
A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply. (2)
- Prepare to remove the cast. - Provide support to the injured extremity.
above-the-knee amputation postoperative (2)
- Prevent internal or external rotation of the limb - Place a sandbag or rolled towel along the outside of the thigh to prevent rotation
A client has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply. (3)
- Preventing additional injury - Providing support - Controlling movement
HIP FRACTURES: clinical manifestations & s/s of Dislocation (7)
- Shortened leg - Adducted - Externally rotated - Fracture of femoral head - Often damage to blood supply - Risk of avascular necrosis - Tx with surgery & joint prosthesis
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply. (4)
- Sit in a straight-backed chair with arm rests. - Avoid hip extension. - Place feet flat on the floor. - Sit with the buttocks "tucked under."
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply. (3)
- The client will experience a tolerable level of pain. - The client will demonstrate wound care. - The client will maintain adequate nutritional intake.
A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply. (3)
- The left leg is shorter than the right. - Limited range of motion of the left hip. - The skin of the lower left leg is pale.
Complications of TKA (total knee arthroplasty)
- Thromboembolism - Infection - Patello-femoral complications - Neurovascular complications - Periprosthetic fractures - Aseptic loosening - Arthrofibrosis
Which of the following are associated with compartment syndrome? Select all that apply. (5)
- Trauma from accidents - Surgery - Casts - Tight bandages - Crushing injuries
venous thrombosis is ? signs and symptoms ? also called ?
- a condition that occurs when a blood clot forms in a vein - calf pain, swelling, warm, tenderness - DVT, deep vein thrombophlebitis
knee replacement full recovery takes about
- about 6 weeks
MRI safety
- absolutely no metal implants - no oxygen tanks - no stretcher in room while MRI is on
venous thrombosis (DVT) treatments & which is greatest prevention ?
- anticoagulants - increase water intake - ambulation is the greatest prevention for DVT!!!!
avascular necrosis
- bone death after a fracture bc a disruption of blood supply - prep patient for removal of necrotic tissue, can lead to prosthetic joint
Hip Prosthesis can last how long ? healing time ? constant threat for ?
- can last 5-15 years - takes 2 months for complete healing - CONSTANT threat for infection
early (3) & late (2) complications of traction
- early DVT(from not moving, get them to do gas pedals & circles), compartment syndrome, fat embolism - late constipation and malunion (if the bone got shifted)
people at highest risk for osteomyelitis (5)
- elderly - obese - diabetes - poorly nourished - rheumatoid arthritis
Which assessment findings would the nurse expect to find in the client with osteomyelitis?
- elevated white blood cell count and erythrocyte sedimentation rate.
phantom limb pain is ? happens when ? most frequent in what surgery ?
- happens right after surgery or months after - most frequent in above knee amputation - complain of numbness, tingling, muscle cramps, feeling that the extremity is present, cramped, twisted
Osteoporosis risk factors
- having a relative (mom, sister etc.) - decreased weight & decreased body mass - lack of weight bearing exercises - small frame and female gender - delayed menarche and/or early menopause - Calcium and Vitamin D are the nutritional influences (ask do they take calcium & vitamin D supplements)
What areas of the body may be examined when bone densitometry is done? Select all that apply. (3)
- hip - spine - wrist
compartment syndrome could be critical if
- if something isn't done in 4-6 hours you could lose the limb
good bone healing needs (3)
- immobilization - good blood supply - weight bearing helps
red flags after total hip replacement
- increased pain at surgical site - groin pain - abnormal external or internal rotation - restricted ability or inability to move affected leg - reporting of a popping sensation in hip
Prednisone (steroids) you should watch for ? increase ? makes what more difficult ?
- infection in long term use - increases blood glucose levels - makes it more difficult to heal
post op of amputation of a lower extremity
- lay on abdomen for 30mins, 3 or 4 times a day to avoid flexion contractures (leg going up or outward)
total knee replacement or (arthroplasty) (TKA) nursing interventions (5)
- monitor drains - report any signs of bleeding - ice & elevate - encourage bending exercises even on bedrest - start with walker then cane
total hip nursing care (3)
- monitor wound drainage - change dressings - up and moving patient on 1st post-op day
symptoms of compartment syndrome (5)
- numbness - tingling - unrelenting pain (no matter what/how much medicine its not helping) - decreased peripheral pulses - pallor & coolness in extremity
can get osteomyelitis 2 ways
- outside (grass, dirt etc.) - inside (bacteria inside the body ex: staph aureus)
skeletal traction
- pull exerted directly on the skeletal system by attaching wires, pins, or tongs into or through a bone - Continuous - Greater wt.( 25-40 lbs) - Ropes not frayed, Weights hang freely & Knots secured
discharge teaching for hip fracture
- regular bone density testing - increase calcium in diet - fall prevention measures (no rugs, steps, move cords) - weight bearing exercises - keep hips abducted
compartment syndrome treatment (2)
- removing the cast, if that doesn't help then .... - Fasciotomy, to allow room for the tissue to swell. Incision is left open until swelling reduces enough to close.
fat embolism manifestations (4) & interventions (3)
- seen usually 24-48 hours but can be up to 10 days - if symptoms are missed there is a 50% chance of living and might get ARDS (respiratory distress syndrome) - might show rash over area (chest) - restless, mental staus changes, tachycardia - can give high flow oxygen - give IV fluids - have crash cart ready/ CPR just in case
bucks traction is ... and treats what ?
- skin traction that can be put back on and uses a slow pulling motion and a system of weights, ropes & pulleys - treats fractures, realign broken bones, correct contractures or deformities and for knee immobility
Patients with Low back pain should sit how ? what 4 diagnostic test ?
- straight back chair with arm rest is what you want your patient to sit in - avoid hip extension - sit with buttocks tucked under - may use CT, MRI (can see in-pinched nerves) , Ultrasound, X-Ray(can see broken bones, inflammation) to diagnose and treat
with osteomyelitis vital signs symptoms (2), test ran (2) & medication given ?
- tachycardia - High HR - CBC ordered - wound & blood culture - usually put on vancomycin for 3-6 weeks
5 types of casts
1. Short - below-elbow cast 2. Long - extends from the palm and wrist to the axilla (armpit) 3. Body 4. Spica - stabilizes a femur fracture or a hip joint after surgery (from waist down both legs) 5. Walking - a walking boot
5 P's
1. paresthesia (Tingling or prickling, "pins-and-needles" sensation; occurs in the arms, hands, legs, or feet.) 2. pain 3. pallor 4. paralysis 5. pulse (pulselessness)
normal lab value for Calcium (Ca)
9.5-10.5 mg/dL
impacted fracture
A fracture with bone fragments driven into another bone fragment.
Pathologic Fracture
A spontaneous fx at the site of a bone disease such as a tumor or osteomyelitis.
in post op care you want to keep the legs
Always keep legs abducted
What diagnostic test would evaluate muscle weakness or deterioration?
An electromyography
greenstick fracture
An incomplete fracture where one side is broken and the other side is bent
A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention?
Application of a cast. After skeletal traction is discontinued, internal fixation, casts, or splints are used to immobilize and support the healing bone
A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action?
Applying a cold pack to the injured site
A client comes to the clinic 2 days after sustaining a to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?
Applying heat. After 2 days, when swelling is no longer likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Applying cold compresses is only used in the first 24 to 48 hours after an injury to reduce swelling and relieve pain.
Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?
Assessing the left leg
A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?
Autologous blood donation
An older adult client has fallen in the home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication?
Avascular necrosis (AVN)
A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client?
Bone scan
The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?
Buck's traction, Fractures of the proximal femur are immobilized with Buck's traction prior to surgical fixation.
total knee joint replacement uses
CPM (continuous passive motion), therapy uses machines to move a joint passively without the patient exerting any effort
A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge?
Client is able to perform transfers safely.
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?
Decreased height
A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?
Document the findings
The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?
Elastic compression bandages
The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action?
Explain the risks of flexion contracture to the client.
A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription?
Extra weight is needed initially to keep the limb in proper alignment. The traction weights applied initially must overcome the shortening spasms of the affected muscles.
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?
Fat embolism syndrome
Intra-articular Fracture
Fracture line extends through the articular surface of the bone
avulsion fracture
Fracture resulting from the strong pulling effect of the tendons or ligaments at the bone attachment.
oblique fracture
Fracture that is at an angle across the bone
Transverse Fracture
Fracture that is straight across the bone.
A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?
Gauntlet casta, a short arm cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb, with the thumb also being casted.
Urine Calcium/Phosphorous
Negative
Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?
Nonunion
Stress Fracture
Occurs as a result of repeated stress to the bone
ORIF
Open Reduction with Internal Fixation (orthopedic surgery)
Meperidine (Demerol) drug class
Opioid
strain
Over stretching of tendon. Tendons are broad, flat sheets of connective tissue that attach muscles to bones, soft tissue, and other muscles.
What medication causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.
Prednisone, a corticosteroid
A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide?
Remove all small rugs from the home
What assessment findings of the leg are consistent with a fracture of the femoral neck?
Shortened, adducted, and externally rotated
With fractures of the femoral neck, the leg is
Shortened, adducted, and externally rotated
comminuted fracture
The bone is broken into multiple small pieces.
skin traction
Traction applied by the use of elastic bandages or adhesive
what is the antidote for warfarin
Vitamin K
non displaced fracture
a break in which the broken bones retain their alignment
pulmonary embolism
a sudden blockage in your pulmonary arteries, the blood vessels that send blood to your lungs and can be caused by immobility precipitated by a fracture
Amphiarthrosis joints
allow limited movement
BKA & AKA
below the knee amputation/above the knee amputation
fat embolus is not a
blood clot, its a glob of fat that is in the blood stream and causes a blockage of blood flow in the (usually) lungs
malunion
bony break that has healed but is not aligned correctly
clients with long bones are at risk for
fat embolism
pyrexia is
fever
complete fracture
fracture that is completely separated
spiral fracture
fracture that is twisted around the shaft of the bone.
Diarthrosis joints are
freely movable
intracapsular
has more blood supply which is bad to break
for pulmonary embolism doctor will order
heparin drip, Heparin works by activating antithrombin III to slow or prevent the progression of DVT and to reduce the size and frequency of PE
ESR (Erythrocyte sedimentation rate) and Sed Rate is the same thing and it looks for
inflammation in your bones
Lifestyle risk factors for osteoporosis include
lack of exposure to sunshine.
PTT (partial thromboplastin time)
measures how long it takes for a clot to form in the blood sample - the PTT value is used to increase, decrease, or hold heparin therapy
what assessment do you do first before calling health care provider
neurological
infection in the bones medical term
osteomyelitis
older people are more likely to get hip conditions because of
osteoporosis
below-the-knee amputation postoperative (3) & complications (5)
postoperative actions: - Prevent edema - Do not allow the stump to hang over the edge of the bed - Do not allow the client to sit for long periods of time to prevent contractures complications: - phantom limb pain - joint contractures - hemorrhage - infection - skin breakdown
delayed union
prolongation of expected healing time for a fracture - can happened because of diabetes, infection, autoimmune disorders - takes usually 6-9 months to heal
what is the reversal for heparin drip
protamine sulfate
shirker socks are used to
put the limb into a cone shape
joint arthroplasty
refers to the surgical removal of an unhealthy joint & replacement of joint surfaces with metal or synthetic materials.
incomplete fracture
remains attached and there is only a portion of a bone broken
What is arthroplasty
replacement of diseased joint with artificial device
delayed nonunion
results for failure of the end of bones to unite
A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?
sprain, which is injuries to the ligaments surrounding a joint.
with traction you don't do what to a patient unless you have a doctors order ?
turn them !!!!
