Lewis 62 Surgerys
The registered nurse is teaching the student nurse about the aim of surgical procedures on common joints. Which understanding of the student nurse indicates the need for further teaching? Correcting deformity Relieving acute pain Improving joint motions Removing intraarticular erosion
Rationale The alleviation of acute pain would need a pharmacologic therapy. Surgery is aimed at relieving chronic pain, not acute pain. Deformities of the joints are corrected by surgery. Surgery improves joint motion because surgical procedures correct the immobility of joint. Intraarticular erosion is removed with the help of surgery.
A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription? Use a walker and two-person transfer technique. Transfer the patient to the chair using a mechanical lift. Ensure a knee immobilizer is in place and elevate the leg while sitting. Ask the physical therapist to assist to limit weight bearing while the patient gets out of bed.
Rationale The nurse should apply a knee immobilizer for stability before helping the patient out of bed. This is a standard measure to protect the knee during movement after surgery. A mechanical lift would not be necessary, because the patient can fully weight bear on the unaffected leg. A walker and assistance from the physical therapist may be considered, but the priority action would be to stabilize the knee and elevate it while sitting.
Which part of the joint enables progression of inflammation to other parts of the joint? Tendons Ligaments Articular cartilage Synovial membrane
Basic pathologic changes in a joint occur within the synovial membrane. Removal of the thickened synovium prevents extension of the inflammatory process into tendons, ligaments, and adjacent articular cartilage.
Which joint surgery involves removing a slice of bone? Osteotomy Arthroplasty Synovectomy Debridement
Rationale Osteotomy is the removal of a slice of bone to change the alignment of the joint and to improve weight-bearing capacity. Arthroplasty is the reconstruction or replacement of a joint to relieve pain, improve or maintain a range of motion, and correct deformity. Synovectomy is the removal of synovial membrane. It is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA). Debridement is the removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint.
The nurse is completing discharge teaching with an older patient who underwent a right total hip arthroplasty he. The nurse identifies a need for further instruction if the patient states they need to do what? Avoid crossing his legs Use a toilet elevator on toilet seat Notify future caregivers about the prosthesis Maintain hip in adduction and internal rotation
The patient should not force the hip into adduction, or force the hip into internal rotation, because these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching.
Which complication is being addressed when the nurse assists the patient with physical therapy exercises following shoulder surgery? Fibrosis Fat embolism Thromboembolism Compartment syndrome
Rationale Frozen shoulder, or fibrosis 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.
Which joints is considered an ideal sight for surgical fusions? Hip joint Knee joint Wrist joint Elbow 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.
A patient with profound osteoarthritis is recommended for total hip arthroplasty (THA). The patient asks why this will relieve the discomfort. What is the nurse's best response? THA will remove degenerative debris from the joint allowing for increased mobility and decreased pain. THA removes a wedge of bone to restore alignment to the joint, alleviating pain and promoting mobility. THA will provide increased mobility for patients with arthritis by reshaping the ball of the femur rather than replacing it. THA can provide significant pain relief for patients with joint deterioration from arthritis by replacing the ball-and-socket joint as well as the upper shaft of the femur
Rationale An arthroplasty is a procedure that relieves pain and promotes mobility by reconstructing or replacing a joint; a THA removes the ball-and-socket joint and the upper shaft of the femur. A hip resurfacing arthroplasty is an alternative to THA that allows the ball of the joint to be preserved and reshaped. An osteotomy removes a wedge or slice of bone to restore alignment and shift weight-bearing, thus relieving pain. A debridement procedure removes degenerative debris from the join to relieve pain and promote mobility.
On return from surgery, the patient is wearing intermittent sequential compression stockings that the patient does not want to keep on. How should the nurse explain their necessity to the patient while on bed rest? The stockings keep the legs warm while the patient is not moving much. The stockings maintain the blood flow to the legs while the patient is on bed rest. The stockings keep the blood pressure down while the patient is stressed after surgery. The stockings provide compression of the veins to keep the blood moving back to the heart.
Rationale Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings
Which postoperative drug class is used in the pain management of joint surgical procedures? Antibiotics Oral opioids Anticoagulants Corticosteroids
Rationale Oral opioids are part of the pharmacologic therapy to manage pain after joint surgical procedures. Antibiotics treat infection after surgery. Anticoagulants treat thromboembolism. Corticosteroids treat fat embolism.
While completing an admission history for a patient with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for the admission. The nurse expects the patient to relate which response to this question? Recent knee trauma Debilitating joint pain Repeated knee infections Onset of "frozen" knee joint
Rationale The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. Recent knee trauma, repeated knee infections, and onset of "frozen" knee joint are not primary indicators for a knee arthroplasty.
The nurse is completing discharge teaching with a patient who has undergone total knee arthroplasty. Which statement would indicate the need for additional teaching? <p>The nurse is completing discharge teaching with a patient who has undergone total knee arthroplasty. Which statement would indicate the need for additional teaching?</p> "I will increase intake of vitamins and minerals." "I should expect that my knee may change shape." "I should continue physical therapy as prescribed." "I will report pain or swelling to the health care provider."
Rationale The patient should report a change in the shape of the knee, which could signal the onset of complications. Reporting pain or swelling, continuing physical therapy, and supplementing vitamins and minerals are all correct.
Which condition can be prevented with anticoagulant drugs in a patient who underwent orthopedic surgery? Fat embolism Bone infection Thromboembolism Compartment syndrome
Rationale Thromboembolism can be prevented with anticoagulant drugs. These drugs diminish hypercoagulability. Antibiotics reduce bone infection. Corticosteroids treat fat embolism. Proper management techniques and surgery can relieve compartment syndrome.
