Caring for Clients Requiring Orthopedic Treatment

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What does the success of an amputees rehabilitation depend on?

Age, type of amputation, condition of the stump, physical status, condition of the remaining limb, concurrent debilitating illness, visual-motor coordination, motivation, acceptance, and cooperation

Before sending a client home after surgery, the nurse should do what, regarding the clients home?

Identify modifications that will be necessary, such as relocating the bed to a ground floor level

When would a bivalve cast be used?

If the arm or leg swells, a client is being weaned from a cast, when a sharp x-ray is needed, or as a spint

What is an important nursing intervention related to the nursing diagnosis of Risk for Disuse Syndrome?*

Place a client with a leg amputation in the prone position several times a day to promote stump extension and prevent contractures

The intake of what nutrients should be increased in clients receiving orthopedic treatment?

Protein and fiber

What is external fixation?**

When the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins

What is necessary for the nurse to determine, if a clients disorder was treated previously?**

Whether and complications or problems occurred because of or during treatment

What is a short arm cast?**

a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. If the thumb is also casted, it is referred to as a thumb spica or gauntlet cast

What is a splint?**

a device that immobilizes and supports an injured body part in a functional position

Body cast

a larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests

Cast

a rigid mold that immobilizes, aligns, and supports an injured structure while it heals

What prosthesis are available for arm amputees?

a shoulder harness with cables that attach to a mechanical terminal device (hook), a semifunctioning cosmetic hand, and a myoelectric arm

What are examples of surgical procedures to correct joint deformity?

arthrodesis, arthroplasty, hemiarthroplasty, total arthroplasty, and osteotomy

What is an important nursing implication related to the nursing diganosis Acute Pain?

change the clients position within prescribed limits, to relieve pressure on bony prominences and promote comfort

What is the pattern of occurrence of phantom pains?*

They can persist for months or decades, or can come and go

What is disadvantage and an advantage of a plaster of Paris cast?**

They require longer time for drying but mold better to the client and are intentionally used until the swelling subsides

Why shouldn't you use your fingertips or a hard surface while supporting a drying cast?

This can cause the cast to push against the skin and could lead to a pressure sore

What is a short leg cast?*

A cast that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position.

What machines should a client who has undergone knee or hip replacement use?*

A continuous passive motion (CPM) machine

What are some principles of effective traction?**

(Make sure that the weights hang freely, not on the floor), be sure that ropes move freely through each pulley, apply the exact amount of weight prescribed

The amount of flexion for clients with hip replacment should never exceed how many degrees?**

30

What is traction?

A method of pulling structures of the musculoskeletal system

What is a myoelectric arm?

A prosthetic that has a realistic-looking hand that is activated by electrical impulses from muscles in the upper arm

What is very important for clients who have knee or hip replacement?**

Anticoagulant therapy and early ambulation

If a client is scheduled for a knee or hip replacement, what should the nurse withhold from the client?*

Aspirin before the surgery to reduce the risk for excessive bleeding

Why should a client with a total hip replacement have the legs abducted with pillows or abductor cushion and extended?**

Because the opposite positions of adduction and flexion beyond 90 degrees can dislocate the prosthetic femoral head from the acetabelum

Ideally, when does postoperative nursing being?*

Before the surgery

What are two examples of skin traction?

Bucks traction and Russell's traction

How is skin traction achieved?**

By applying devices to the skin that indirectly affect the muscles or bones

What kind of injuries do Crutchfield cranial tongs effect?*

Cervial spine fractures

What are the potential complications in the late postoperative period of amputation?

Chronic osteomyelitis, and burning pain

What should be assessed immediately after application of a cast?*

Circulation, (sensation, and mobility) in exposed fingers and toes every 1-2 hours

What is the first step in applying a cast?**

Clean and dry the skin surface of the part to be casted

What two materials are casts general made of?

Fiberglass, or plaster (plaster of Paris)

What are the potential complications in the immediate postoperative period of amputation?**

Hematoma, hemorrhage, pain, and infection

What instructions should a nurse provide to the client about a brace?

Instructions on how to apply the brace and to administer scrupulous skin care to prevent irritation and injury

What are the advantages of a myoelectric arm?*

It eliminates the need to wear a harness, the terminal device looks natural, and it has somewhat better function than the cosmetic hand

How can the crust be removed from the skin?**

It usually sheds in a few days, (but lotions and warm baths or soaks may help to soften the skin and remove debris)

How should a cast be supported while it dries?

On pillows

What is an important nursing implication related to the nursing diagnosis Impaired Tissue Integrity ?*

Massage bony prominences and skin surfaces subjected to pressure, unless they remain red when pressure is relieved

What is used to stabilize a fracture in internal fixation?

Metal screws, plates, rods, nails, or pins

How will the skin appear, once a cast is removed?*

Mottled and may be covered in a yellowish crust composed of accumulated body oil and dead skin

What are examples of types of casts?

Short arm cast, long arm cast, short leg cast, long leg cast, walking cast, body cast, shoulder spica cast, hip spica cast

What is closed amputation? (flap)

Skin flaps cover the severed bone end

If the client is awake during the cast application, what should the healthcare professionals explain to them about the feeling of the cast application?

The cast material will feel warm during application as a result of being mixed with water

What is an expected outcome for a nursing diagnosis of Impaired Tissue Integrity?*

The client will demonstrate adequate wound healing without infection

Why are porous-coated cementless joints components often used instead of traditional prosthesis?*

These allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place

What is phantom pain?

The feeling that the amputated portion of the limb still remains

What is Bucks traction used for?*

The relief of muscle spasms and pain in clients with fracture femers that have surgery delayed

What is skeletal traction?

Tractions that is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield)

After a knee or hip replacement, the client should notify the physician if what is present?**

Unusual drainage at the incision site, fever, chills, sudden onset of pain, redness, or swelling

What are important points to prevent infection when providing pin care?*

Use at least one applicator per pin, do not use applicator more than once, gently remove crusts around the pin sites, obtain a culture if purulent drainage is present

What is closed reduction?*

When a bone is restored to its normal position by external manipulation

What is open reduction?**

When a bone is surgically exposed and realigned in the operating room

When would a client use a splint?*

When a musculoskeletal position (does not require rigid immobilization), causes large degree of swelling, (requires special skin treatment, such as the monitoring of a sutured laceration)

When is a cast window created?*

When the client reports discomfort under the cast or (has a wound that requires a dressing change)

What are braces?

devices that provide support, control movement, and prevent additional injury

Cylinder cast

encircles an arm or leg, leaving the fingers or toes exposed

What is the goal of a CPM machine?*

for the client to have the ability to bend the knee 90 degrees by discharge

Postoperative complications after surgical procedures to correct joint disfunction

hemorrhage, subluxation, infection, thromboembolism, and avascular necrosis

For what conditions may amputation be performed?

malignant tumors, long standing infections of bone and tissue that prohibit restoration of function, extensive trauma to an extremity, death of tissues, thermal injuries, deformity rendering a limb a hindrance, life-threatening disorders

Because the pin sites are an entry for infection, what is necessary?

monitoring for redness, drainage, and tenderness

Hip Spica cast

surrounds one or both legs and the trunk

If an amputee is acutely ill, what should the nurse monitor?

the client circulation in the limb for changes, such as severe pain, color changes, and lack of peripheral pulses

What is an open amputation? (guillotine)

the end of the residual limb is temporarily open with no skin covering it

What is an arthodesis?**

the fusion of a join (most often the wrist or knee) for stabilization and pain relief

What is staged amputation?

the guillotine method is first used, then a few days later a closed amputation is done

What is a total arthroplasty?*

the replacement of both articular surfaces within one joint

When is open reduction required?**

when (soft tissues, suck as nerves or blood vessels, are caught between the ends of the broken pieces of bone; when the patella and other joints are fractured), the bone has a wide separation, open fractures are evident, would debridement is necessary, or internal fixation is needed

When is staged amputation done?

when a client has severe infection and gangrene

What is open reduction internal fixation (ORIF) accomplsihed with?**

wire, nails, plate, and/or (an intramedullary rod, IM rod)


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