Chapter 40

Osteomyelitis

A nurse is caring for a patient 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 patient faces a high risk of what infectious complication?

Patient is able to perform transfers safely

A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge?

Inform the surgeon of this finding

A nurse is emptying an orthopedic surgery patients closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurses best action?

Improving the patients level of function

A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurses choice of interventions?

Risk for impaired skin integrity

A nurse is planning the care of a patient who will require a prolonged course of skeletal traction. When planning this patients care, the nurse should prioritize interventions related to which of the following risk nursing diagnoses?

Reporting signs of impaired circulation

A nurse is providing discharge education to a patient who is going home with a cast on his leg. What teaching point should the nurse emphasize in the teaching session?

Bending down to put on socks

A nurse is reviewing a patients activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation?

Obstructed arterial blood blood to the forearm and hand

A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?

-Preventing additional injury -Providing support -Controlling movement

A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply.

Extra weight is needed initially to keep the limb in proper alignment

A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the patients affected limb are spastic. How does this change in muscle tone affect the patients traction prescription?

Document this as an expected assessment finding

A patient has recently been admitted to the orthopedic unit following total hip arthroplasty. The patient has a closed suction device in place and the nurse has determined that there were 320 mL of output in the first 24 hours. How should the nurse best respond to this assessment finding?

Applying a cold pack to the injured site

A patient has suffered a muscle strain and is complaining of pain that she rates a 6 on a 10-point scale. The nurse should recommend what action?

Bucks extension traction

A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur?

The physical therapist will likely help you get up using a walker the day after your surgery

A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

Compartment syndrome

A patient is complaining of pain in her casted leg. The nurse had administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication?

Autologous blood donation

A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?

Make sure you don't bring your knees close together

A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postop period, what health education should the nurse emphasize?

Maintain consistent traction tension while repositioning.

A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?

Keep your right leg elevated above heart level

A patient with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the patients cast care?

Assess the surgical site and the affected extremity

A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurses best action?

Application of a cast

A physician writes an order to discontinue skeletal traction on an orthopedic patient. The nurse should anticipate what subsequent intervention?

Keep the patients hips in abduction at all times

A nurse is caring for a patient who is postop day 1 right hip replacement. How should the nurse position the patient?

Assess the pin insertion site every 8 hours

A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should the nurse include in the plan of care?

Us of a pressure-relieving mattress

A 91 year old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the patients plan of care. What intervention is most justified in the care of this patient?

Numbness and burning of the feet

A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the patient may have aperoneal nerve injury?

The patients tibial nerve is functional

A nurse is assessing a patient who is receiving traction. The nurses assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding?

Promptly inform the primary care provider

A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is unable to palpate the patients dorsalis pedis or posterior tibial pulse and the patients foot is pale. What is the nurses most appropriate action?

Turning from side to side

A nurse is caring for a patient in skeletal traction. in order to prevent bony fragments from moving against one another, the nurse should caution the patient against which of the following actions?

Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists

A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?

The cast will only have full strength when dry

A nurse is caring for a patient who has had a plaster arm cast. Immediately postapplication, the nurse should provide what teaching to the patient?

I will need my husband to assist me in getting off the low toilet seat at home

A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the patients statements would indicate to the nurse that the patient requires further teaching?

Signs of neurovascular compromise

An elderly patients hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurses priority assessment?

Knots in the rope should not be resting against pulleys

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?

Teach the patient to perform ankle and foot exercises within the limitations of raction

The nurse has identified the diagnosis of risk for impaired tissue perfusion related to deep vein thrombosis in the care of a patient receiving skeletal traction. What nursing intervention best addresses this risk?

Protect the affected leg from internal rotation

The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis

Within 30 minutes, then every 1 to 2 hours

The nurse is helping to set up Bucks traction on an orthopedic patient. How often should the nurse assess circulation to the affected leg?

Increased warmth of the calf

The nursing care plan for a patient in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a patients lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)?

Balanced traction allows for greater patient movement and independence than other forms of traction

The orthopedic surgeon has prescribed balance skeletal traction for a patient. What advantage is conferred by balanced traction?

Risk for peripheral neurovascular dysfunction

While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient?

Teach the patient to perform deep breathing and coughing exercises

a nurse is caring for a patient receiving skeletal traction. Due to the patients severe limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to prevent these complications?