Med Surg Chapter 41

List the danger signs of possible circulatory constriction that the nurse should assess for in a casted extremity

unrelieved pain, swelling, discoloration, tingling, numbness, inability to move fingers or toes, or any temperature changes.

The most effective cleansing solution for care of a pin site is

Chlorhexidien solution

Name three major complications of an extremity that is casted, braced, or splinted

Compartment syndrome, pressure ulcers, and disuse syndrome

The nurse is caring for a postoperative hip replacement patient knows that the patient should not cross his or her legs at any time for __________ after surgery

4 months

The nurse is very concerned about the potential debilitating complication of perineal nerve injury. What symptom doe site nurse recognize as a result of that complication?

Footdrop

Unreleived pain for patient in a cast must be immediately reported to avoid __________, ____________,___________ and ____________

Necrosis, impaired tissue perfusion, pressure ulcer formation, possibly paralysis

The nurse assesses a patient after a total right hip arthroplasty and observes a shortening of the extremity, and the patient complains of severe pain in the right side of the groin. What is the priority action of the nurse?

Notify the physician

A nursing goal for a patient with skeletal traction is to avoid infection and the development of _______________ at the site of pin insertion

Osteomyelitis

A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur?

Peroneal nerve

What potential immobility related complications may develop when a patient is in a skeletal traction?

Pressure ulcers, atelectasis, pneumonia, constipation, anorexia, urinary statsis and infection, and venous thromboemboli with PE or DVT

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for?

Pulmonary embolism

Open reduction

The correction and alignment of the fracture after surgical dissection and exposure of the fracture

Meniscectomy

The excision of damaged joint fibrocartilage

Fasciotomy

The incision and diversion of the muscle fascia to relieve muscle constriction, as in compartment or to reduce fascia contracture

Tendon Transfer

The insertion of a tendon to improve function

Bone graft

The placement of bone tissue or to replace diseased bone

Amputation

The removal of a body part

Arthroplasty

The repair of joint problems through the operating arthroscope or through open joint surgery

Hemiarthroplasty

The replacement of one of the articular surfaces

What is volkmanns contracture?

a serous complication of impaired circulation in the arm. Contracture of the fingers and wrist occurs as the result of obstructed arterial blood flow tot the forearm and the hand. The patient is unable to extend the fingers, describes abnormal sensation, and exhibits signs of diminished circulation to the hand. Permanent damage develops within a few hours if action is not taken.

Describe compartment syndrome

occurs when the circulation and function of tissue within a confined area is compromised. Treatment requires that the cast be bivalved; a fasciotomy may be necessary

What are the five "p's" that should be assessed as part of the neuromuscular check?

pain, pallor, pulslessness, parenthesia, and paralysis

The nurse suspects "compartment syndrome" for a casted extremity. what characteristic symptoms would date nurse asses that would confirm these suspicions?

Decrease sensory function Excruciating pain loss of motion

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient?

Eat emboli syndrome

Internal fixation

The stabilization of the reduced fracture by the use of metal screws, plates, wires, nails and pins

The nurse completes a neurovascular assessment of either the fingers or toes of a casted extremity to determine circulatory status. What expected outcomes does the nurse anticipate will occur?

The toes or fingers should be pink, warm, and easily moved (wiggled) There should be minimal swelling and discomfort. The blanch test should be carried out to determine rapid capillary refill

The nurse suspects that a patient with and arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer?

Ulna styloid

The nurse knows to assess a patient for deep vein thrombosis by assessing the lower extremities for:

Unilateral calf tenderness, warmth, redness, swelling

An artificial joint for fatal hip replacement involves an implant that consists of _____________, ___________, and ___________

an acetabular socket, a femoral shaft, a spherical ball

What methods for preventing hip prosthesis dislocation would the nurse teach the patient?

1. Keep the knees apart at all times 2. put a pillow between the legs when sleeping 3. Never cross the legs when seated 4. Avoid bending forward when seated in a chair 5. Avoid bending forward to pick up and object on the floor 6. Use high seated chair and a raised toliet seat 7. Do not flex the hip to put on clothing such as pants, stockings, socks, or shoes

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?

24 hours

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal?

Apply an emollient lotion to soften the skin Control swelling with elastic bandage as directed Gradually resume activities and exercise

A patient arrives in the emergency department with a suspected born fracture of the right arm. How does the nurse expect the patient to describe the pain?

Sharp and piercing

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated?

The left leg is internally rotated

Name four purposes for having a cast application

1. Reducing a fracture 2. Correcting a deformity 3. Applying uniform pressure to underlying soft tissue 4. Providing support and stability for weak joints

List four reasons for a patient to have traction application

1. to minimize muscle spasm; to reduce, align, and immobilize fractures

The nurse expects that _______ of weight can be used for patient in skeletal traction

25 pounds

After a total hip replacement, the patient is usually able to resume daily activities after __________

3 months

After a total hip replacement, stair climbing is kept to a minimum for _________ to _________ months

3 to 6 months

The nurse is caring for a patient with a total hip replacement. How should the nurse allow this patient to turn?

45 degrees onto the the unoperated side if the affected hip is kept abducted

Compare the advantages of a fiberglass cast to those of a plaster cast

A fiberglass cast si light in weight and water resistant. It is more durable than plaster and water resistant.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

Abduction

A patient with an arm cast complains of pain. what nursing interventions should the nurse provide in order to reduce the incidence of complications?

Asses the fingers for color and temperature Assess for a pressure sore Determine the exact site of the pain

The nurse assesses for perineal nerve injury by checking the patient's casted leg of the primary symptoms of ________, ______, and _________.

Burning, numbness and tingling

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homan's sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg