Nursing - 309 Post Op Hips and Knees (Iggy Ch 51, 18)

When educating a patient about total joint arthroplasty (TJA), what does the nurse do first?

Assesses the patient's knowledge about TJA.

A client had an above the knee amputation of the left leg because of trauma from a motor vehicle collision. The health care provider orders ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's FIRST intervention?

Determine if the client has ever used crutches before.

On the first postoperative day after a total hip replacement, a client asks for assistance onto the bedpan. What should the nurse instruct the client to do?

Flex the knee on the unoperated leg and pull on the trapeze to lift the pelvis.

A patient injured a lower extremity and has been placed in a running traction. What instructions does the nurse give to the UAP?

Moving the patient or the bed during care can alter the countertraction.

What is an important health teaching point for a patient with TJA?

"Protect the joint."

A client is in skin traction while awaiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's BEST INITIAL response?

"I can't because the eights are needed to keep the bone aligned."

A nurse provides discharge teaching for a client who had a total hip replacement. Which activities to avoid identified by the client indicate an understanding of the teach?

Crossing the legs. Sitting in a low chair.

During morning care, a patient with a below the knee amputation asks the UAP about prostheses. How will you instruct the UAP to respond?

"I'll ask the nurse to come in and discuss this with you."

A patient with a right above the knee amputation asks you why he has phantom limb pain. What is your best response?

"Phantom limb pain is not explained or predicted by any one theory."

The nurse is caring for a patient with open reduction and internal fixation (ORIF) for a hip fracture. Because the patient is at risk for hip dislocation, the nurse ensures that the hip is maintained in which position?

Abduction

The patient has returned from the post anesthesia care unit after TJR. Which interventions will the nurse use to prevent venous thromboembolism?

Apply sequential compression devices (SCDs). Administer subcutaneous enoxaparin (Lovenox) as ordered. Teach the patient to perform leg exercises such as flexion and dorsiflexion.

The nurse is interviewing an older adult with a history of osteoporosis who reports falling and catching her weight on her outstretched dominant hand. This patient is most likely to have sustained what type of fracture?

Colles' wrist fracture.

Postoperative care for total knee replacement may include which technique?

Continuous passive motion used immediately or several days post operatively. Ice packs or cold packs to the incisional area. The use of CPM machine in the daytime and an immobilizer at night.

A patient is receiving low molecular weight heparin therapy to prevent post operative deep vein thrombosis (DVT). Which routine assessments are most important for this patient during anticoagulation therapy?

Ensure that anti-embolic stockings or sequential compression devices are in use. Monitor complete blood count (CBC) and platelets counts. Check stools for occult blood. Monitor the surgical site for bleeding.

What should be included in the nurse's instructions to help a client prepare for walking with crutches?

Exercises with or without weights to strengthen the muscles of the upper extremities.

A patient who underwent a right above the knee amputation 4 days ago also has a diagnosis of depression. Which order would you clarify with the health care provider.

Give fluoxetine (Prozac) 40 mg once a day.

Which nursing intervention is best to prevent increased pain in a patient experiencing phantom limb pain?

Handle the residual limb carefully when assessing the site or changing the dressing.

A client has a total knee replacement, and a continuous passive motion device is being used. The nurse concludes that the teaching was effective when the client states, "The goal of this therapy to--"

Improve joint flexion."

How does a continuous peripheral nerve blockage (CPNB) device work?

Infuses a local anesthetic into the surgical site.

A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity?

Internal rotation with extension of the knee and hip.

AN older adult patient has skin traction in place for a hip fracture. What is the main purpose of this type of traction?

It decreases painful muscle spasms.

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse understands that aseptic necrosis is associated with which factor?

Loss of blood supply to the head of the femur.

After an above the knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain in a discussion with the client?

Nerve endings in the limb are still intact and react to stimuli.

A nurse is caring for a client with a fracture of the head of the femur. The health care provider places the client in a buck extension. What explanation does the nurse give the client for why the traction is being used?

Reduces muscle spasms.

A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of the traction?

Relieve muscle spasm and pain.

What should the nurse do to control edema of the residual limb 1 week after a client has an above the knee amputation?

Rewrap the elastic bandage as necessary.

A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has an order for ambulation with slight weight bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive devise does the nurse expect the health care provider to order for this client?

Standard walker

A client is ready to walk with crutches after knee surgery. Which crutch walking technique will the nurse most likely have to reinforce after the client returns from physical therapy?

Three-point

The charge nurse is assigning the nursing care of a patient who had a left below the knee amputation 1 day ago to an experienced LPN, who will function under your supervision. What will you tell the LPN is the major focus for the patient's care today?

To monitor for signs of sufficient tissue perfusion.

A nurse is caring for a client who has had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery?

Toes for mobility.

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase the countertraction?

Use a slight Trendelenburg position.

An older patient is discharged to home following an orthopedic injury. Which mobilization device is usually preferred for older patients who need additional support for balance?

Walker

A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain is the benefit of bearing most of the weight on the unaffected?

Will help maintain the strength of the unaffected limb

An excited group of teenagers brings a friend to the ED who severed a finger while playing sports. The bleeding from the site is well controlled and the patient is alert and stable. What does the nurse do with the severed finger?

Wrap it in dry gauze, place it in a waterproof bag, and put the bag in ice water.

The nurse is preparing an educational program for student nurses on the orthopedic unit. Which three signs of hip dislocation would be included in this offering?

Increased pain. Leg rotation. Shortening of affected leg.

Following a meniscectomy, the nurse assists a patient to immediately start performing which exercises?

Straight leg raises on both legs.

The nurse applies bandages to a patient's residual limb in order to help shape and shrink the limb for a prosthesis. What is the proper technique for the nurse to use?

Use a figure eight wrapping method to prevent restriction of blood flow.

A patient is reluctant to consider hip surgery because of fear of blood transfusion reaction. What is the nurse's BEST response?

"You could donate your own blood for several weeks before surgery."

A nurse is caring for a client who had a total hip replacement. What nursing action should be incorporated into the plan of care to prevent thrombus formation?

Encouraging the client to perform ankle exercises.

A nurse is caring for a client who had a total hip replacement. What is the priority assessment when monitoring the client for hemorrhage?

Examining the bedding under the client

A nurse receives a change of shift report for a client who had a total hip replacement 24 hours ago. After reviewing the client's clinical record and completing a physical assessment, which complication should the nurse conclude that the client is experiencing?

Fat embolism

Which factor carries the greatest risk for hip fracture?

Osteoporosis

Which interventions can the nurse use to prevent or manage infections in patients who have undergone total joint replacement?

Use aseptic technique for wound care and emptying of drains. Wash hands thoroughly when caring for patients. Culture drainage fluid if a change is observed. Report excessive inflammation or drainage to the provider.

Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses?

Amplitude and symmetry.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?

Use a pillow to keep the legs abducted.

The care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture?

Flexion of the hip.

Which crutch gait should the nurse teach the client wearing a prosthesis after a single leg amputation?

Four point.

A client experiences a traumatic amputation of a leg in a motor vehicle accident. Which nursing intervention INITIALLY should receive the lowest priority?

Teaching residual limb care.

Which principle should the nurse consider when assisting a client with crutches to learn the four point gait?

The client must be able to bear weight on both legs.

What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation?

Turn the client to the prone position routinely.

A client has surgery to repair a fractured right hip. Where should the nurse stand when assisting the client to ambulate?

On the client's left side.

Postoperative total hip replacement patients can develop numerous complications. Which interventions are most important in preventing complications?

Adequate diet and fluid intake. Getting out of bed on the first post operative day. Frequent assessment of the patient's pain.

The nurse is providing care for a patient scheduled for a THA. Which medications should the patient receive before surgery?

Anti-hypertensive tablet orally.

It is important to monitor which lab tests for patients on anticoagulant therapy with LMWH after TJA?

CBC. Platelet count.

A patient who has sustained a traumatic amputation of the left leg expresses concern about working and taking care of his family after his injury. What resources does the nurse recommend to help the patient adjust to his lost limb?

Chaplain. Medical Social Worker. National Amputation Foundation.

The pain a patient experiences from a bone fracture results from which processes?

Edema. Muscle spasms.

A nurse is caring for a client in the evening after the client has had a below the knee amputation. What action should be implemented by the nurse?

Elevate the foot of the bed.

Which interventions does the nurse implement to improve mobility for a patient who has undergone a THR?

Encourage use of assistive devices such as a walker when ambulating. Instruct in the use of a raised toilet seat.

A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent a hip flexion contracture?

Lie on the abdomen 30 minutes four times daily.

A patient reports dramatic changes in color and temperature of the skin over the left foot with intense burning pain, sensitive skin, excessive sweating, and edema. The physician makes a preliminary medical diagnosis of complex regional pain syndrome. What is the priority for nursing care?

Management of pain.

For patients who have TJAs, the risk of DVT is high. Which statements are true?

Older adults are at high risk for DVT and compromised circulation. Patients with a history of DVT are at high risk for recurrence. Leg exercises must be started in the immediate post operative period.

Which position should a nurse avoid placing a client who had surgery for a total hip replacement?

Orthopneic

A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. On which part of the body should the nurse instruct the client to place weight?

Palms of the hands

A patient is admitted to the same day surgery unit following a meniscectomy. What does post operative care for this patient include?

Perform neurovascular checks every hour for the first few hours and then every 4 hours. Check the surgical dressing for bleeding. Teach about signs and symptoms of infection.

A nurse is caring for a client with a below the knee amputation. What should the nurse encourage the client to do to prepare the residual limb for a prosthesis?

Press the end of the residual limb against a pillow periodically.

The nurse is caring for a patient with an above the knee amputation (AKA). In order to prevent hip flexion contractures, how does the nurse position the patient?

Prone position every 3 to 4 hours for 20 to 30 minute periods.

For pre operative care of a patient scheduled for TJA. What does the nurse plan to do?

Provide written or videotaped information about the procedure. Assess the patient's understanding of the procedure. Assess and include the patient's support people or family. Include interdisciplinary providers, if possible.

Which pre operative tests are performed for a patient scheduled to undergo a total hip arthroplasty (THA)?

x-ray of operative hip. Computed tomography (CT) of operative hip. Magnetic resonance imaging (MRI) of operative hip.

A young patient had a great toe amputated because of severe injury. The patient is depressed and withdrawn after the physician tells him that the amputation will affect balance and gait. What is the nurse's best response?

"When the doctor was explaining things to you, what were you thinking about?"

The nurse assesses a postoperative TKR patient for neurovascular compromise. Which assessments must the nurse document?

Skin color and temperature. Presence or absence of distal peripheral pulses. Capillary refill of operative leg. Comparison of operative leg to nonoperative leg.

After an open reduction and internal fixation of a fractured hip. What assessments of the client's affected leg should the nurse make?

Skin temperature. Sensation in the toes. Presence of pedal pulse.

The patient is a middle aged man with a history of uncontrolled diabetes. His right foot is a dark brownish purple color and there is no palpable dorsalis pedis or posterior tibial pulse. The nurse prepares the patient for which diagnostic test.

Doppler ultrasound.

Which are contraindications for TJA?

Infection. Advanced osteoporosis. Severe inflammation.

What instructions should the nurse provide when the client is allowed out of bed after an above the knee amputation?

Keep the hip in extension and alignment.

Adlea is a refined capsaicin product. What is the advantage of infusing this drug directly into the surgical joint during knee surgery?

Patients experience less acute post operative pain.

Which is an example of the principles of body mechanics that the nurse uses when caring for immobilized clients?

Placing the feet apart to increase the stability of the body.

The nurse's neighbor comes running over because her husband "cut his finger off with a power saw." After calling for help, what is the first priority action when the nurse gets to the neighbor's house?

Assess for airway or breathing problems.

Which clinical indicator should the nurse expect to identify when assessing a client with a fracture of the neck of the femur?

Shortening of the affected extremity with external rotation.

When a client is in the right side lying position after the insertion of a left hip prosthesis, the nurse ensures that the client has a pillow placed between the thighs and that the entire length of the upper leg is supported. What does this pillow prevent?

Strain on the operative site.

To prevent a DVT, several types of anti coagulant medications can be ordered. Which is the most commonly used drug during hospitalization?

Subcutaneous LMWH

A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective?

Unilateral chest pain. Sudden onset of shortness of breath.

When should the nurse begin the process of rehabilitation when a client is scheduled for an amputation?

Before the surgery.

The nurse is preparing an educational session for a patient who is scheduled to undego hip replacement. Which potential complications does the nurse make the patient aware of?

Venous thromboembolism. Hip dislocation. Neurovascular compromise. Infection.