Amputations and Joint replacement
After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse correctly interprets these findings as indicating which of the following? A. developing infection. B. Bleeding in the operative site C. Joint dislocation. D. Glue seepage into soft tissue.
A. Incorrect because Clinical manifestations of an infection would include inflammation, redness, erythema, and possibly drainage and separation of the wound. B. incorrect Bleeding could be external (e.g., blood visible from the wound or on the dressing) or internal and manifested by signs of shock (e.g., pallor, coolness, hypotension, tachycardia). C. Correct The joint has dislocated when the client with a total joint prosthesis develops severe sudden pain and an inability to move the extremity D. inccorect, The seepage of glue into soft tissue would have occurred in the operating room, when the glue is still in the liquid form. The glue dries into the hard, fixed form before the wound is closed.
A client in the postanesthesia care unit with a left below-the-knee amputation has pain in her left big toe. Which of the following should the nurse do first? A. Tell the client it is impossible to feel the pain. B. Show the client that the toes are not there. C. Explain to the client that her pain is real. D. Give the client the prescribed opioid analgesic
A. Incorrect because The patients pain is always what they say it is, phantom limb pain is a real sensation. B. Incorrect because, Showing the lack of toes the patient has does nothing to solve the issue., and is an inappropriate action C. incorrect. although this is something that you would do, verifying her pain does not relieve it. Saying this may calm their apprehensions. D. Correct: Give the client the prescribed opioid analgesic: correct because, phantom sensation is a real sensation that should be treated with prompt medical intervention to relieve the pain, although the sensation usually goes away.
The client asks the nurse, "Why can't the physician tell me exactly how much of my leg he's going to take off? Don't you think I should know that?" On which of the following should the nurse base the response? A. The need to remove as much of the leg as possible. B. The adequacy of the blood supply to the tissues. C. The ease with which a prosthesis can be fitted. D. The client's ability to walk with a prosthesis.
A. Incorrect: The need to remove as much of the leg as possible. Incorrect. a moral, ethical, and legal viewpoint, the surgeon attempts to remove as little of the leg as possible B. Correct. The adequacy of the blood supply to the tissues: The level of amputation often cannot be accurately determined until during surgery, when the surgeon can directly assess the adequacy of the circulation of the residual limb. C. Incorrect. The ease with which a prosthesis can be fitted: incorrect. Although a longer residual limb facilitates prosthesis fitting, unless the stump is receiving a good blood supply the prosthesis will not function properly because tissue necrosis will occur D. Incorrect. The client's ability to walk with a prosthesis. Incorrect. the client's ability to walk with a prosthesis is important, it is not a determining factor in the decision about the level of amputation required
The nurse cares for a patient one week after a below the knee amputation for diabetic complications. The patient describes the uncomfortable sensation that the limb is still present. After several failed interventions, the nurse and collaborative care team decide to attempt mirror box therapy. How can the nurse best explain this therapy to the patient? A. We will place the affected limb inside a box that emits specific wavelengths of light to help the nerves heal. B. The mirroring box is a balancing technique that will treat the vertigo that is partially responsible for your discomfort. C. The mirror box tricks your brain into thinking that you still have the limb, which alleviates the pain. D. Visual feedback is used to create more effective accessory muscle use which takes strain off of other parts of the body, decreasing referred pain
A. Incorrect: We will place the affected limb inside a box that emits specific wavelengths of light to help the nerves heal.. B. Incorrect.The mirroring box is a balancing technique that will treat the vertigo that is partially responsible for your discomfort.. C. Correct: The mirror box tricks your brain into thinking that you still have the limb, which alleviates the pain. D. Incorrect: Visual feedback is used to create more effective accessory muscle use which takes strain off of other parts of the body, decreasing referred pain. .
Priority Decision: AN immediate prosthetic fitting during surgery is used for a patient with a traumatic below the knee amputation. During the postoperative period what is the priority nursing intervention? A. monitor the patients vital signs B. assess the incision for hemorrhage C. elevate the residual limb (stump) on pillows D. have the patient flex and extend the knee every hour
A. correct: because the device covers the stump the surgical site/bleeding cannot be directly seen B. incorrect. hemorrhage is not apparent on dressings C.Incorrect.: not necessary because the device itself prevents edema D.INCORRECT: exercises are contraindicated in the immediate postop period, avoiding the disruption of ligatures and the suture line.
The nurse has an order to get the client out of bed to a chair on the first postoperative day following total knee replacement. The nurse plans to do which of the following to protect the knee joint? A. apply a compression dressing and put ice on the knee while sitting B. obtain a walker to minimize weigh-bearing by the client on the affected leg C. lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine D. apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
A. incorrect because The leg is elevated while the client is sitting in the chair to minimize edema. Ice is not used unless prescribed and this action does not protect the patients knee joint during transfer. B. incorrect because This intervention is not decided by the nurse, the surgeon orders the weight-bearing limits on the affected leg which would aid in protection but not the best answer. C. incorrect because A compression dressing should already be in place on the wound and A CPM machine is used only while the client is in bed, again helpful in preventing dvt but not protecting the joint during ambulation D. correct, apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting: the immobilizer protects the patients joint and provides stability during the transfer process and elevation decreases edema.
The patient with a hand deformity requires a prosthesis following a surgical procedure. Which factor would be considered, that would best help determine the type of prosthesis needed? A. The patients amount of pain after the amputation B. The reason for the amputation C. The use of the prosthetic after placement D. The level of amputation
A. incorrect. Pain bears no weight on the type of prosthesis required for functionality. B. incorrect. Cause of amputation holds no bearing on what prosthesis is needed C. Incorrect. use of prosthesis can help determine the specifics of the prosthesis is helpful but not the best indicator. D. correct. The level of amputation: The type of prosthesis is contingent upon the level of amputation.
A patient with severe ulnar deviation of the hands undergoes an arthroplasty with reconstruction and replacement of finger joints. Postoperatively what is the most important action for the nurse to do? A. position the fingers lower than the elbow B. perform neurovascular assessments of the fingers q2-4 hr. C. Encourage the patient to gently flex, extend, abduct, adduct, the finger's q4 hr. D. remind the patient that function of the hands is more important than their cosmetic appearance
A.incorrect because hands are elevated with a bulky dressing B. Correct. perform neurovascular assessments of the fingers q2-4 hr. is correct because, it is essential to detect compromised vascular and neuro function caused by trauma or edema. C. incorrect, because exercises are performed 3-4 x a day when splints are removed and pt is discharged. This information is not needed at this time. D. Incorrect This is not the most important intervention because the cosmetic appearance of their hands post-surgery is greatly emphasized prior to procedure. Although their appearance is of concern to the pt. it is not most important
After hip replacement, include the following discharge instructions to the patient and caregiver: Select all that apply A. Do not cross legs at knees or ankles: B. Sit on a low toilet seat to prevent falling C. Do not use pillow between legs for the first 6 weeks after surgery when lying on non operative side or supine D. Do not force hip into an angle greater than 90 degrees of flexion E. Do not put on own shoes without a long handled shoe horn until 4-6 weeks after surgery
ADE A. Correct, This puts the patient at risk for dislocation B. Incorrect the idea of sitting on a low toilet seat, is to prevent falling. But Sitting on a low seat causes the hip to be flexed more than 90 degrees and can cause dislocation. Pt should use an elevated toilet seat. C.Incorrect the Use of a pillow is necessary the first 6 weeks to keep the legs from crossing and to keep hips aligned to avoid dislocation. D. correct, Do not force hip into an angle greater than 90 degrees of flexion: An angle greater than 90 degrees causes dislocation. E. correct, Do not put on own shoes without a long handled shoe horn until 4-6 weeks after surgery: The action of bending over to put on shoes creates an angle greater than 90 degrees and risk for dislocation.
Following a lower extremity amputation, the nurse should include the following discharge instructions in her teaching to the patient: Select all that apply A. Lie supine with the hip in extension for 30 minutes 3-4 times per day B. Elevate the residual limb on a pillow C. Wash the residual limb each night with warm water and a bacteriostatic soap. Expose to air for 30 minutes. D. Inspect daily for signs of irritation especially erythema, excoriation and odor as well as areas prone to pressure. E. Perform ROM to all joints and general strengthening exercises to upper extremities daily.
CDE A. Incorrect: Lie supine with the hip in extension for 30 minutes 3-4 times per day: Be careful not to read the question too quickly. Read the question twice and look for key words the second time. The patient should lie PRONE, not supine. B. Incorrect: Elevate the residual limb on a pillow: the key word in the stem of the question is discharge instructions. Elevation is done in the first 48 hours only after surgery in order to reduce edema of the stump. At home, elevating the residual limb will cause contracture of the hip and should be avoided C.correct, Wash the residual limb each night with warm water and a bacteriostatic soap. Expose to air for 30 minutes : Washing the limb each night with anti-bacterial soap cuts down on the risk of infection. Bacteria thrives in moisture. Air drying for 30 minutes allows the stump to completely dry before putting the sock or prothesis back on. Air drying instead of drying with a towel avoids irritation to the skin. D.correct, Inspect daily for signs of irritation especially erythema, excoriation and odor as well as areas prone to pressure.: these can be signs of infection or skin breakdown. E. correct, Perform ROM to all joints and general strengthening exercises to upper extremities daily.: a person with an amputation has lack of mobility or decreased mobility. ROM is needed daily to avoid contractures, keep joints flexible, reduce pain, and improve balance and strength. Keeping upper extremities strong with strength training is necessary for the patient with a LE amputation as he will require more upper body strength when using a wheelchair or crutches.
