#1 Adults: Orthopedic Nursing

when might a fat embolism occur?

1 hr to one week

nursing care of hip fractures (6)

1. no adduction 2. turn to unaffected side 3. ambulate within 24 hours 4. don't bend more than 90 degrees 5. neurovascular checks Q4 6. use foam splint or pillows between the legs

the incision for a knee replacement is 8-___ inches on the front of the joint

12

how soon should you ambulate someone who has had a hip fracture

24 hours

weight range for skeletal traction

25-35

if someone has a hip fracture, neurovascular checks should be done every ____ hr

4

avascular necrosis can occur prior to surgery or....

4-6 months after fracture

skin traction requires what weight? (range)

5-10 pounds

no flexion of > ____ degrees; only bend as far as a raised toilet seat

90

what type of fluid makes a halo type appearance on a dressing?

CSF

factor in bone healing responsible for bone cell formation

Ca+2

with traction comes immobility, so we must monitor for...

DVT, pneumonia, ileus, renal calculi

T or F for joint trauma only give NSAIDs when the patient requests

FALSE

after a lumbar puncture what position should the patient be in?

HOB elevated; bedrest

increased internal or external pressure due to a poor cast fitting, edema, or hemorrhage

compartment syndrome

what is the major problem with amputations

contractures

what is the priority in a spinal fracture...to decompress the ____

cord

spinal injury at C1-C3 causes

death from cardiovascular and respiratory collapse

spinal injury at C3-C5 causes

death from respiratory failure

treatment for compartment syndrome where you surgically slice through the skin until the patient bleeds

decompressive fasciotomy

in spinal shock, what happens to your BP and heart rate

decrease! both decrease

abnormal healing time, but is usually under 6 months

delayed union

loss of articulation of the bone ends in the joint caps

dislocation

7 principles of cast care:

elevation; turn/rotate; skin edges/pad prn; pain control; window/bivalve (relieves pressure); neurovascular checks; hot spots/drainage

tennis or golfers elbow; inflammation of tendon at point of origin to bone

epicondylitis

25% of patients with long bone fractures end up with ___ ________

fat embolus

release of fat from exposed bone marrow attract platelets and occludes small vessels causing ischemia, increased capillary permeability and fluid shift

fat embolus

where is avascular necrosis most common?

femoral head

the #1 cause for triggering autonomic dysreflexia is a...

full bladder

4 steps of bone healing

hematoma, fibrocartilaginous callus formation, bony callus formation, remodeling

newer technique for hip repair; shaving and capping of the bone; reduces post op complications, potential to last longer, and if it fails we have a back up plan

hip resurfacing

bone grafts are usually taken from what site?

iliac crest or tibia

treatments for repetitive injuries ...

immobilize and rest ice for 24-48hours and then heat -medications like NSAIDS -corticosteroid injections into the joint

what type of exercises are performed if a patient has joint trauma (these help strengthen the muscle)

isometric

how long can spinal shock last?

it can start immediately and last up to 4-6 weeks

complete spinal injury means...

its across the whole cord

logrolling technique is used in patients who have just had what surgical procedure?

laminectomy

type of traction that is intermittent and can be removed throughout the day (2)

lumbar and cervical

who is more likely to get spinal graters 1. female 19yrs 2. female 39 3. male 24 4. male 15

male 24

growth of bone fragments in faulty position

malunion

spinal shock is cause by...

massive vasodilation following a cervical or high thoracic injury

3 components of care for skeletal traction

never remove weights; clean the pins; check pins for infection

no bone healing within 6-9 months

non-union

surgical manipulation of bone to fix a fracture

open reduction

bone infection resulting in high fever and chills; redness to ulceration and drainage

osteomylitis

treatment of fat embolus

oxygen therapy and corticosteroids

symptoms accompanied with a bone fracture

pain, edema, crepitus, deformity

5Ps of neurovascular checks

pallor, pulses, parasthesia, paresis, pain

spinal injury at or above T1 causes

paraplegia

numbness/tingling

paresthesia

auto graft: from ____ allo grat: from ____

patient donor

what test is done for carpal tunnel?

phalen test

it is considered a hip fracture if it is in what location...

proximal 1/3 of the femur

spinal injury at or above C8 causes

quadraplegia

S&Sx of fat embolus

respiratory depression, cerebral dysfunction, petechiae

skin traction is ____ term and skeletal traction is ____ term

short; long

components of nursing care for skin traction

skin assessments; protect pressure sites

what type of fracture takes priority? skull, facial, or ribs?

skull

partial dislocation where bone ends still partially touch

subluxation

complete vs incomplete

total segment vs partial segment

T or F in a total knee replacement, the quadriceps muscle and tendon are cut, and damaged tissue is removed

true

T or F in traction weights hang freely and do not touch the floor

true

T or F infection risk is greater with skeletal traction

true

symptoms of compartment syndrome (first 48) (4)

unrelenting pain, cyanosis, weakness, paresthesia

needed to absorb calcium

vitamin D

unstable vs stable

with or without displacement

simple vs compound

closed vs open

advantages and disadvantages of internal fixation

advantages: fast ambulation; good stabilization disadvantages: surgery required

if this lab value is elevated we look for bone disease

alkaline phosphatase

if a patient has a spinal cord injury at or above t6 they are at risk for what for the rest of their life?

autonomic dysreflexia

why do arterial pulses remain normal if someone has compartment syndrome?

because the major arteries are usually outside the compartment

uptake of dye shows inflammatory process

bone scan

autonomic dysreflexia causes _____cardia and _____tension

brady; hyper

inflammation of bursa

bursitis

6 factors in bone healing

calcium, vitamin D, no osteoporosis, no infection, good blood circulation, alkaline phosphatase

compression of median nerve and inflammation of the lining of synovial sheath

carpal tunnel syndrome

if a patient is allergic to shellfish then what might be of concern regarding diagnostic radiology?

certain types of dye

manipulation of the skin to fix the fracture

closed reduction