Chapter 61: Caring for Clients Requiring Orthopedic Treatment

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is:

"CPM increases range of motion of the joint."

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse?

Assess for complications.

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

Encourage the client to avoid scratching, and obtain a prescription for an antihistamine if severe itching persists.

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

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

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

Maintain consistent traction tension while repositioning.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

Teach the client how to prevent problems caused by immobility.

A client with a lengthy history of degenerative joint disease is being seen by an orthopedic surgeon. What joints are most commonly replaced? Select all that apply.

hip, knee

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

24 hours

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand

Which would be contraindicated as a component of self-care activities for the client with a cast?

Cover the cast with plastic to insulate it

A client is being treated for severe pain in the left foot. After radiographs, the orthopedist diagnoses a stress fracture and prescribes treatment. Why doesn't the orthopedist surgically reduce the foot

"Make sure you don't bring your knees close together."

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

A client 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?

Buck's extension traction

A nurse is giving instructions to a client who's going home with a cast on his leg. Which teaching point is most critical?

Reporting signs of impaired circulation

A nurse is planning the care of a client who will require a prolonged course of skeletal traction. When planning this client's care, the nurse should prioritize interventions related to what risk nursing diagnosis?

Risk for Impaired Skin Integrity

Which device is designed specifically to support and immobilize a body part in a desired position?

Splint

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?

Within 30 minutes, then every 1 to 2 hours

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?

chronic osteomyelitis and causalgia

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?

Explain that the sensation being felt is normal and will not burn the client.

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse?

A splint is applied when more swelling is expected at the site of injury."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

"Metal pins will go through my skin to the bone."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device."

A nurse is reviewing a client's 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?

Bending down to put on socks

After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?

Discuss the complications that the client's may experience if he doesn't cooperate with the care plan.

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?

Keep your right leg elevated above heart level."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

Limit hip flexion to 90 degrees."

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?

Monitor bowel function daily.

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

A hip spica cast:

encloses the trunk and a lower extremity.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

osteomyelitis

The nurse teaching the client with a cast about home care includes which instruction?

Dry a wet fiberglass cast thoroughly to avoid skin problems

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?

Osteomyelitis

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

Promptly inform the primary provider.

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

Protect the affected leg from internal rotation.

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

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

Which action by the nurse would be inappropriate for the client following casting?

Protect the cast by covering with a sheet.

A nurse is emptying an orthopedic surgery client's 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 nurse's best action?

Inform the surgeon of this finding.

A client with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, the client reports a new onset of pain at the surgical site. What is the nurse's best action?

Assess the surgical site and the affected extremity.

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

Abduction

Which would be an inappropriate initial pain relief measure for the client with a cast?

Application of a new cast

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

Keep the client's hips in abduction at all times.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?

Never cross the affected leg when seated

The nurse assesses a patient after 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 patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain?

Sharp and piercing

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?

Signs of neurovascular compromise

Which statement describes 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.

A client is being treated for severe pain in the left foot. After radiographs, the orthopedist diagnoses a stress fracture and prescribes treatment. Why doesn't the orthopedist surgically reduce the foot?

Bones are already aligned.