Prep-U Ch. 61 Caring for Clients Requiring Orthopedic Treatment

The client who has had an arm amputated is assigned to nursing care. What potential complications should the nurse closely monitor for in the late postoperative period of the client? A. chronic osteomyelitis and causalgia B. sleeplessness, nausea, and vomiting C. hematoma, hemorrhage, and infection D. kidney dysfunction

A. chronic osteomyelitis and causalgia - In the postoperative course, the nurse should monitor for potential complications such as chronic osteomyelitis (after persistent infection) or, rarely, a burning pain or causalgia, the cause of which is unknown.

Arthrodesis is: A. fusion of a joint (most often the wrist or knee) for stabilization and pain relief. B. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. C. replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. D. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

A. fusion of a joint (most often the wrist or knee) for stabilization and pain relief. - Arthrodesis is fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Arthroplasty is total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. Hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. Osteotomy is the cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

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. A. Elevate the arm above the heart. B. Prepare to remove the cast. C. Provide support to the injured extremity. D. Assess neurovascular status every 8 hours. E. Apply ice to extremity.

B, C - The nurse should anticipate immediate removal of the cast and provide support to the injured extremity. Neurovascular status should be assessed more frequently than every 8 hours. If the client's neurovascular status is not improving, then a fasciotomy may be needed. Waiting 8 hours to assess neurovascular status may cause permanent damage to the extremity. To promote arterial blood flow, the arm should be elevated to the heart level, not above. Ice should not be used, as it could further decrease blood flow to the extremity.

A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client's cast care? A. "Cover the cast with a blanket until the cast dries." B. "Keep your right leg elevated above heart level." C. "Use a clean object to scratch itches inside the cast." D. "A foul smell from the cast is normal after the first few days."

B. "Keep your right leg elevated above heart level." - The leg should be elevated to promote venous return and prevent edema. The cast shouldn't be covered while drying because this will cause heat buildup and prevent air circulation. No foreign object should be inserted inside the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? A. Have the patient extend both hands while the nurse compares the volume of both radial pulses. B. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. C. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. D. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

B. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. - The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

Which statement describes external fixation? A. The bone is restored to its normal position by external manipulation. B. The bone is surgically exposed and realigned. C. The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. D. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied.

C. The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. - In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication? A. Cellulitis B. Septic arthritis C. Sepsis D. Osteomyelitis

D. Osteomyelitis - Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic client because of the risk of osteomyelitis. Orthopedic clients do not have an exaggerated risk of cellulitis, sepsis, or septic arthritis when compared to other surgical clients.

Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply. A. Apply cold packs B. Apply a new cast C. Administer analgesics D. Elevate the involved part E. Provide passive range of motion

A, C, D - Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed, and by administering analgesics. The application of a new cast and providing passive range of motion would not assist in decreasing initial pain for a client with a cast.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? A. "Limit hip flexion to 90 degrees." B. "Perform rotation exercises each day." C. "Intermittently cross and uncross your legs several times each day." D. "Avoid weight bearing until the hip is completely healed."

A. "Limit hip flexion to 90 degrees." - The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? A. "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." B. "The continuous passive motion device can decrease the development of adhesions." C. "Bleeding is a complication associated with the continuous passive motion device." D. "Monitoring skin integrity is important while the continuous passive motion device is in place."

A. "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." - Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

Which would be contraindicated as a component of self-care activities for the client with a cast? A. Cover the cast with plastic to insulate it B. Cushioning rough edges of the cast with tape C. Elevate the casted extremity to heart level frequently D. Do not attempt to scratch the skin under a cast

A. Cover the cast with plastic to insulate it - The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote? A. Knots in the rope should not be resting against pulleys. B. Weights should rest against the bed rails. C. The end of the limb in traction should be braced by the footboard of the bed. D. Skeletal traction may be removed for brief periods to facilitate the client's independence.

A. Knots in the rope should not be resting against pulleys. - Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.

A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? A. The left leg is internally rotated. B. The leg length is the same as the right leg. C. The client has discomfort when moving in bed. D. There are diminished peripheral pulses on the affected extremity.

A. The left leg is internally rotated. - The nurse must monitor the client for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. The length of the leg with a dislocated prosthesis may be shorter. The client's discomfort will not indicate a dislocation. Diminished peripheral pulse of the affected extremity would be a indication of circulation issues.

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? A. Within 30 minutes, then every 1 to 2 hours B. Within 30 minutes, then every 4 hours C. Within 30 minutes, then every 8 hours D. Within 30 minutes, then every shift

A. Within 30 minutes, then every 1 to 2 hours - After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours.

Which would be an inappropriate initial pain relief measure for the client with a cast? A. Application of cold packs B. Application of a new cast C. Administration of analgesics D. Elevation of the involved part

B. Application of a new cast - Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.

Which cleansing solution is the most effective for use in completing pin site care? A. Betadine B. Chlorhexidine C. Hydrogen peroxide D. Alcohol

B. Chlorhexidine - Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? A. Permanent paresthesias B. Foot drop C. Deep vein thrombosis (DVT) D. Infection

B. Foot drop - Injury to the peroneal nerve as a result of pressure is a cause of foot drop (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating.

A client who has a fractured femur has been put in traction and requires assistance with care activities. A nursing diagnosis associated with the client's procedure is "Impaired Tissue Integrity related to puncture wound from pin placement." Which intervention would not be incorporated into the client's care related to this diagnosis? A. Provide pin care per agency protocol. B. Monitor bowel function daily. C. Protect bony prominences from pressure by using pressure-relieving techniques under elbows, heels, and coccyx. D. Assess traction frequently to ensure proper alignment and to prevent pressure areas.

B. Monitor bowel function daily. - Although this is part of the care for the client in traction, it does not pertain to impaired tissue integrity. All of the following are interventions related to impaired tissue integrity: protect bony prominences from pressure by using pressure-relieving techniques under elbows, heels, and coccyx; assess traction frequently to ensure proper alignment and to prevent pressure areas; and provide pin care per agency protocol.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? A. Replacement of one of the articular surfaces of a joint B. Incision and diversion of the muscle fascia C. Excision of damaged joint fibrocartilage D. Replacement of knee with artificial joint

C. Excision of damaged joint fibrocartilage - The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

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? A. Polyethylene-induced infection B. Pneumonia C. Fat emboli syndrome D. Disseminated intravascular coagulation

C. Fat emboli syndrome - Fat embolism syndrome (FES) (see Chapter 43) may occur with orthopedic surgery. The nurse must be alert to any signs and symptoms that may suggest the development of FES. These may include respiratory distress; onset of delirium or any acute change in level of consciousness; and development of unusual skin rashes, especially a papular rash on the upper torso.

The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a client receiving skeletal traction. What nursing intervention best addresses this risk? A. Encourage independence with ADLs whenever possible. B. Monitor the client's nutritional status closely. C. Teach the client to perform ankle and foot exercises within the limitations of traction. D. Administer clopidogrel as prescribed.

C. Teach the client to perform ankle and foot exercises within the limitations of traction. - The nurse educates the client how to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT. Nutrition is important, but does not directly prevent DVT. Similarly, independence with ADLs should be promoted, but this does not confer significant prevention of DVT, which often affects the lower limbs. Clopidogrel is not normally used for DVT prophylaxis.