NUR102 - Chp. 61 - Caring for Clients Requiring Orthopedic Treatment

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." * Promote venous return and prevent edema.

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

"Make sure you don't bring your knees close together." * After receiving a hip prosthesis, the affected leg should be kept abducted (away from the body). Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the client's legs do not need to be higher than the level of the chest.

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." * In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction.

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

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

A client is admitted to the orthopedic unit in skeletal traction for a fractured proximal femur. Which explanation should the nurse give the client about skeletal traction?

"Traction involves passing a pin through the bone." * In skeletal traction, a metal pin or wire is passed through the bone and traction is then applied using ropes and weights attached to the pins. * Used when greater weight (11 to 18 kg [25 to 40 lb]) is needed to achieve the therapeutic effect.

A client has a fractured right arm. What are the advantages of applying a fiberglass cast? Select all that apply.

- Causes fewer skin problems. - Lighter Weight. - Breathability. * Fiberglass casts dry more quickly, are lighter in weight, longer lasting, and breathable. Clients with synthetic casts have fewer skin problems and may bear weight soon after the cast is applied depending upon the type of fracture. Casts are rigid and do not accommodate edema.

A client with a fractured ulna has a plaster cast applied to the forearm. Which action(s) will the nurse take when caring for the client and cast? Select all that apply.

- Ensure a free flow of air around the cast. - Test cast dryness with the palm of the hand. - Determine the cast is dry when it is white and shiny.

A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply.

- Increasing fluid intake. (Decreases stasis by lessening hemoconcentration.) - Maintaining antiembolic stockings. (Standard of care when preventing DVT.) - Administering enoxaparin. (Standard of care when preventing DVT.)

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

24 hours. * Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.

External Fixation

A fracture treatment procedure in which metal pins are placed through the soft tissues and bone so that an external appliance can be used to hold the pieces of bone firmly in place during healing; then attached to a compression device.

Skeletal Traction

A metal pin or wire is passed through the bone and traction is then applied using ropes and weights attached to the pins; used when greater weight (11 to 18 kg [25 to 40 lb]) is needed to achieve the therapeutic effect.

A client has a compound fracture of the right femur. Due to the nature of the fracture, open reduction will be used to align the femur. What other rationale requires the use of open reduction?

All options are correct. * Open reduction is required when soft tissue, such as nerves or blood vessels, is caught between the ends of the broken pieces of bone; the bone has a wide separation; comminuted fractures are present; patella and other joints are fractured; open fractures are evident; wound debridement is necessary; or internal fixation is needed.

Prosthesis

An artificial device to replace a body part such as a joint.

Splint

Appliance used for fixation, support, and rest of an injured body part in a functional position.

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. * Unrelieved pain can be an indicator of a complication, such as compartment syndrome.

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. * Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

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

Balanced traction allows for greater client movement and independence than other forms of traction. * Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some client movement, and facilitates client independence and nursing care while maintaining effective traction.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

Cut a cast window. * After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing.

Avascular Necrosis

Death of bone from an insufficient blood supply.

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

Dry a wet fiberglass cast thoroughly to avoid skin problems. * Instruct the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin.

Internal Fixation

Fracture treatment in which pins or a plate are placed directly into the bone to hold the broken pieces in place.

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 nurse is planning the care of a client who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions?

Improving the client's level of function. * Improving function is the overarching goal after orthopedic surgery.

Osteomyelitis

Infection of the bone.

Compartment Syndrome

Involves the compression of nerves & blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles; a buildup of pressure around your muscles.

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?

Knots in the rope should not be resting against pulleys. * This interferes with traction.

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. * Traction is used to reduce the fracture and must be maintained at all times, including during repositioning.

Traction

Method of pulling structures of the musculoskeletal system to relieve muscle spasm, align bones, & maintain immobilization.

A client who had a total hip replacement two days ago reports new onset calf tenderness to the nurse. Which action should the nurse take?

Notify the health care provider. * Could be a sign of DVT (Deep Vein Thrombosis).

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

Notify the health care provider. * If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation.

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

Numbness and burning of the foot. * Peroneal nerve injury may result in numbness, tingling, and burning in the feet. * Think of paresthesia. If you lay on your arm too long, you get a sensation of paresthesia due to the nerves being compressed/reduced circulation to that extremity. Same concept.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction. * Key word: "exposure." * The correction and alignment of the fracture after surgical dissection and exposure of the fracture.

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. * Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic client because of the risk of osteomyelitis.

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

Osteomyelitis. * May occur after persistent infection in the late postoperative period.

Homans' Sign

Pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis; have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

Subluxation

Partial dislocation.

Closed Reduction

Procedure where fractured bone is restored to its normal position by EXTERNAL manipulation, then immobilized with a bandage, cast, or traction.

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 care provider. * Signs of neurovascular dysfunction warrant immediate medical follow-up.

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. * Abduction (away from the body) of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided.

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. * Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

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

Reporting signs of impaired circulation.

Cast

Rigid mold that immobilizes an injured structure when it heals.

While assessing a client who has had knee replacement surgery, the nurse notes that the client 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 client?

Risk for Ineffective Peripheral Tissue Perfusion. * The hematoma may cause an interruption of tissue perfusion. There is also an associated risk for infection because of the hematoma, but impaired perfusion is a more acute threat.

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

Splint.

Skin Traction or Buck's Traction

Stabilizes the fracture until surgery is performed and uses a boot or Velcro to attach the ropes and weights to the leg.

Braces

Supports made of plastic materials, canvas, leather, or metal that are custom fit to each patient, provide controlled movement, & prevent additional injury.

Open Reduction

Surgical procedure where a fractured bone is EXPOSED & realigned.

Arthroplasty

Surgical reconstruction of a joint, using an artificial joint that restores previous lost function & relieves pain.

A nurse is caring for a client who has had a plaster arm cast applied. Immediately after application, the nurse should provide what teaching to the client?

The cast will only have full strength when dry. * 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.

A 91-year-old client is slated for orthopedic surgery and the nurse is integrating gerontologic considerations into the client's plan of care. What intervention is most justified in the care of this client?

Use of a pressure-relieving mattress. * Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses this risk.