Ortho seminar Brunner Chapters NCLEX style questions

Nursing Care for Traction: Assess neurovascular status

- Check extremity every Hour for first 24 hrs then Q4hr as minimum. -Check skin color, temp, sensation, pulse quality, and edema. -Elevate complaints of paresthesia such as numbness, tingling, increased pain, or sudden pain. always compare with other extremity -Encourage pt to do active flexion-extensions ankle exercises and isometric contraction of calf muscle (calf-pumping exercises) 10 times an hour while awake to decrease venous stasis

Nursing Care for Traction: Prevent skin breakdown

- Client is at higher risk for pressure sores - Check ankles, elbows, heels, and all bony prominences -Other pressure areas include coccyx, sacrum, ears, and scapula -Assess areas for irritation and inflammation frequently -To encourage movement without using the elbows or heels; a trapeze can be suspended overhead withing easy reach for the patient.

Surgical client care:

- Discuss with your client what orthopedic problem is going to be corrected by surgery. - Discuss the surgical procedure with the client, include benefits and risk (provider should really be doing this) -Discuss reasons for joint replacement - Answer questions about types of joint replacement that may be used. -Discuss pre- and post-operative nursing care - Acute and post-op anemia due to postoperative blood loss occurs in pts frequently occurs in patients undergoing total joint replacement. Several units of typed and cross-matched blood should be available.

Nursing care for orthopedic surgery: post-operative orders

- Monitor vital signs and LOC -Monitor Urinary output -Cough and deep breathe every one hour while awake -Check dressings frequently for bleeding -Monitor drains -Preform neurovascular checks -Prevent dehydration -Pain management -Apply anti-embolism stocking/ prevent VTE - Monitor for infection -Monitor nutrition -Proper positioning -Preform exercises -encourage ambulation -Client education -Check to see that all recovery room orders have been completed -Do NOT assume that pre-operative orders will be resumed after surgery.

Conditions that require joint replacement:

- Osteoarthritis and RA -Trauma -Congenital deformity - Avascular necrosis

other nursing care for traction include...

- Provide skin care -Provide pin skin site care -Promote exercise -Assess anxiety -Assist client with self-care - but maintain independence

what should the client report to the nurse after casting? Nursing diagnosis R/T AEB

- Toes or fingers become blue and, swollen or difficult to move -The limb becomes painful -They feel numbness -They have blister-like sensation or burring pain -Unrelieved pain -Any signs of infection -If anything is dropped into or under the cast

Indications for orthopedic surgery:

- Unstable fractures -Deformity - Joint disease - Infected or necrotic tissue - Impaired circulation -Tumors or groeths

Nursing Care for Traction: Maintain effective traction

- safety equipment -weight is proper amount and hanging freely -Ropes are secure with no fraying of ends -Ropes are int eh wheel grooves of the pully -Knots are tied securely and away from the pulley

Nursing interventions for casting

-Asses general health of client -Assess the client's skin, the cast, and the neurovascular status. This includes assessment of sensory and motor function. -Administer pain medication, apply ice, and elevate the extremity. -Promote skin care; check your client's skin frequently -Monitor for complications -Identify self-care deficits (Daily care, knowledge, and psychosocial deficits

Nursing Care for Traction: Manage and monitor complications

-Atelectasis/ Pneumonia -Constipation -Anorexia - Urinary stasis/ Infection -VTE

Types of joint replacement:

-Hip -Knee -Finger -Shoulder -Ankle -Wrist -Elbow

Purpose of traction is to..

-Minimize pain and muscle spasm, reduce, align, immobilize fractures, and correct or prevent deformities. -Used to increase space between two opposing surfaces. The body part is immobilized by opposing pull at both ends. -Can be an alternative to surgery, the bone can stay in alignment until callus begins. -treats deformities by stretching muscle -Rest the joints -Treats dislocations and subluxations -Prevent contractures -Considered short term intervention until other modalities are possible.

principals of removing a cast

-Warn the client about sounds and what to expect with cast being taken off. -Position appropriately (ex: have client lie supine and with knee rest for the removal of leg cast) Cast padding is cut with scissors and the cast cutter vibrates to break instead of "sawing" -Make sure to check for protocol or by the physicians' orders how to take it off -Support the extremity before and after cast removal, after its off wash the skin and put emollient on -Have the client resume daily activities SLOWLY

Advantages of external fixation:

-immediate fracture stabilization -minimal blood loss occurring in comparison with internal fixation -Increased pt comfort -allowing for early mobilization & ambulation -maintaining alignment of closed fractures that could not be maintained in a cast or splint -permitting wound care with open fractures -Active exercise of adjacent uninvovled joints

Nursing care for external fixator

-prepare the client psychologically for the application of the large, bulky apparatus. -After application, the extremity is elevated to the level of the heart to reduce swelling, monitor neurovascular status frequently every 2-4 hours and promptly report any changes -Assess pin sites for redness, pain, warmth, purulent drainage, or intact or loose pins. Discomfort should be minimal, the nurse may see some serous drainage (clear liquid) mild redness at the pin site the first 48 to 72 hours post insertion, this is normal be sure to document -cover sharp points with caps or gauze dressing to prevent device induced injuries, assess each pin site at least every 8 to 12 hours for redness, swelling, and pain around the pin sites, warmth, and purulent drainage. -strict hand washing before and after pin sites are cared for should always be taken place, clean pin sites per physician order, pins are usually cleaned using sterile saline or Chlorhexidine solution depending on the institution's policies, clean each pin site separately to prevent cross contamination with non-shielding material

Skin tractions is used to ______and ___ an area before________. A. control muscle spasms, immobilize, surgery. B. Control contractures, stabilize, discharge

A.

The nurse is teaching client about a cast home care which instructions would be included? A. keep the cast below the heart level B. dry and wet fiberglass cast thoroughly to avoid skin problems C. cover the cast with plastic or rubber D fix a broken cast by applying tape

A. Instruct the client to keep the cash dry, to a wet fiberglass cast thoroughly to avoid skin problems and to not cover it with plastic or rubber. A cash should be kept dry, but do not cover it with plastic or rubber because this causes condensation which dampens the cast and skin period a cast extremity should be elevated frequently to heart level to prevent swelling period a broken cash should be reported to the physician and the client should not attempt to fix it

_____ are inserted into bone fragments to _______ and _____ the fracture. A. Pins, Stabilize, immobilize B Rods, immobilize, stabilize C. Needles, Join, stop

A. Pins, Stabilize, immobilize

Which statement reflects the progress of bone healing? A. Serial X-rays are used to monitor the progress of bone healing. B. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification. C. The age of the client influences the rate of fracture healing. D. All fractures healing takes place at the same rate no matter the type of the bone fractured.

A. Serial X-rays are used to monitor the progress of bone healing.

Which statement describes paresthesia?

Abnormal sensations; tingling

Principals of traction care...

An equal mix of traction in counter traction is needed. The weight provides the pull. Counter traction is provided by the client's weight. Weight must hang freely from the bed and not rest on the bed or floor. Nurses must see that the client's body is always in good alignment, ropes cannot be obstructed. Do not remove weights unless prescribed do so by the physician. Skeletal traction is always maintained period traction forces directly to the bone. skeletal traction is usually seen in combination with balanced suspension period never interrupt skeletal traction unless a life-threatening situation occurs.

Define traction

Application of pulling force to an injured or diseased part of the body or an extremity.

skeletal traction

Apply directly to the bone by use of metal pin or wire (Steinmann pin, Kirschner wire) tongs may be used to apply traction to the head or skull for cervical fractures. Traction is applied by an orthopedic surgeon using surgical asepsis. Skeletal traction is used to treat fractures of the femur, the tibia, or the cervical spine. May be used with multiple trauma clients that may be to unstable to go to surgery.

Nursing Care for Traction: Maintain proper body position

Avoid foot drop and inward and outward rotation use shoes or foot board

Many patients donate their own ______ (autologous) during _______ preceding their surgery. A Cells, days B. Blood, Weeks C. Skin, weeks D. Blood, days

B.

how should the cast be to avoid compartment syndrome?

Bivalved (cut in half longitudinally to relieve the pressure) elevate the extremity no higher than the level of the heart to insure arterial perfusion.

Straight or running traction is also called

Buck's traction

Which is an indicator of neurovascular compromise? A. Warm skin temperature B. Pain upon active stretch C. Capillary refill of more than 3 seconds D. Diminished pain

C. Capillary refill of more than 3 second

Which is a circulatory indicator of peripheral neurovascular dysfunction? A. Paresthesia B. Weakness C. Cool skin D. Paralysis

C. Cool Skin

Fracture healing occurs in four areas, including the... A. Cartilage B. Bursae C. External soft tissue D. Fascia

C. External soft tissue fracture healing occurs in the bone marrow, bone cortex, periosteum, and external soft tissue, where the bridging callus (fibrous tissue) stabilizes the fracture.

Acute pain with cast/fiber glass:Nursing diagnosis R/T AEB

Client may have some pain, especially if the cast is being applied to support fractures bones.

Self-care deficit: Nursing diagnosis R/T AEB

Clients with a cast may find everyday activities difficult if not impossible to preform

what is the term for rhythmic contraction of a muscle?

Clonus

Facts about traction and counter traction.

Counter traction is usually the client's body weight. Force can be applied with the hands as manual traction or with weights. Traction is not common now since improved fixation techniques. Weight is needed to provide the counter traction period usually; body weight and bed position adjustments provide this counter traction.

Which term refers to a grating or cracking sound or sensation?

Crepitus

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? A. EMG B. Bone Density C. Meniscography D. Arthrography

D. Arthrography

Which term refers to the shaft of the long bone?

Diaphysis

Impaired physical mobility: Nursing diagnosis R/T AEB

Every joint that is not immobilized should be exercised.

what is remodling?

Final stage of fracture repair during which the new bone is reorganized into the bone's former structural arrangement.

fasciotomy

Incision and diversion of the muscle fascia to relieve muscle constriction, as in compartment syndrome, or to reduce fascia contracture.

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?

Isotonic contraction Exercises such as swimming and cycling.

The client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?

Joints

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae

Impaired skin integrity: Nursing diagnosis R/T AEB

Localized pressure within the cast may cause pressure or cast sores, which can be identified by: -Itching beneath the cast -Burning like pain- should not be ignored as it can quickly become ischemic -Swelling of the fingers or toes after the immediate swelling has subsided. - A characteristics of infection (discharge) or tissue necrosis could be causing foul odor.

what are external fixators used for?

Manage fractures with soft tissue damage Alos help with correcting defects. treat nonunion and lengthen limbs.

Joint replacement material

Metal (stainless steel, Cobalt-Chromium, titanium) and high-density polyethylene components. Joints are cemented with polymethyl methacrylate (PMMA), a bone bonding agent.

Open Reduction Internal Fixation (ORIF)

OR: correction and alignment of the fracture after suregical dissection and exposure of the fracture. IF: stabilization of the reduced fracture by the use of metal screws, plates, wires, nails, and pins.

pelvic belt traction

Occasionally used to treat back pains. May relieve muscle spasms and pain associated with disc disease.

6 P's of compartment syndrome

Pain Paresthesias Pallor Pressure Paralysis Pulselessness

Which nerve is being assess when the nurses will ask the client to dorsiflex the ankle and extend the toes?

Peroneal Motor function is assessed by asking client to preform task and also assess sensory function by pricking the skin between the great toe and center toe.

How to treat pressure ulcers in casting?

Physician may need to bivalve the cast or cut a window in the cast to allow for inspection and access to the site. Prevent window edema

During which stage or phase of bone healing after fractures does callus formation occur?

Reparative. Callus formation occurs during the reparative stage, but it is disrupted by excessive motion at the fracture site.

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin: this is bone GLA protein.

Complications of buck's tractions?

Skin breakdown, nerve damage, circulatory impairment Make sure the client is in proper alignment to prevent bone fragments from moving against one another.

Skull sutures are an example of which type of joint?

Synarthrosis joints that are immovable

NURSING ALERT!!!!!!

The nurse never adjusts the external fixator device. The PHYSICIAN is responsible for adjusting the clamps

Which nerve is assessed when the nurse asks the client to spread all fingers?

Ulnar This aids in assessing motor function affected by ulnar innervation, while pricking the fat pad at the top of the small finger allows assessment of the sensory function affected by the nerve.

What is Bryant's traction?

Used for kids less than 35 pounds or under 2 years old with femoral shaft fractures and congenital hip dislocations.

Cervical head halter

Used to treat neck pains

buck's traction (skin type)

applied to lower leg, immobilizes fractures before surgery for proximal femur, all while helping reduce muscle spasms and pain while reducing the fracture Inspect skin and circulation of the site before and while applied. 5-8lbs of weight is applied

closed reduction

bringing bone fragments into anatomic alignment through manipulation and manual traction.

Halo vest

cervical traction designed for the ambulatory client must keep an Allen wrench taped to vest in case of emergency removal of the traction

Types of skeletal traction

cervical, Halo vest, Thomas splint with Pearson attachment- used for fractures of the femur

external fixators are good for what type of fracture?

comminuted giving stable support with treaded pins set in the bone fragments, with a scsffold.

pressure ulcers in casting

common site in the arm is the radial styloid, ulna styloid, olecranon, and lateral epicondyle. Common sites in the legs are the lateral malleolus, peroneal nerve, and the tibial tuberosity.

which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?

compartment syndrome

Complications of casting?

compartment syndrome, pressure ulcers, disuse syndrome

Meniscectomy

excision of the meniscus - damaged joint cartilage

Nursing Care for Traction: Maintain bed rest as ordered

give time for breaks in activity

Tendon transfer

insertion of tendon to improve function

Which description refers to an osteon?

microscopic functional bone unit

compartment syndrome

occurs when there is increased tissue pressure within a limited space; leads to compromises in the circulation and the function of the involved tissue. Leads to vascular insufficiency and nerve compression due to unrelieved swelling.

bone graft

placement of bone tissue to promote healing, to stabilize, or to replace diseased bone

Straight or running traction

pulling force is in a straight line with the body part resting on the bed. Counter traction is provided by client's body weight.

Amputation

removal of a body part, usually a limb or part of a limb

Joint arthroplasty or replacement

replacement of joint surfaces with metal or synthetic materials; may be a total joint arthroplasty or replacement.

Hemiarthroplasty

replacement of one of the articular surfaces when done with the hip, the femoral head and neck are replaced with a femoral prosthesis the acetabulum is not replaced

types of traction

skin and skeletal

What is balanced suspension?

supports the effected extremity off the bed and allows for some client movement without disruption of the line of pull. Counter traction is provided by devices such as slings or splints

arthroplasty

surgical repair or replacement of a joint; through the operating arthroscope or through open joint surgery.

counter traction

the reduction of a fracture by traction from two opposing directions at once

skin traction

using weight to pull on traction tape or on a foam boot attached to the skin. The amount of weight applied must not exceed the tolerance of the kin. No more than 2-3.5 kg (4.5-8#) of traction can be used in an extremity. Pelvic traction is usulayy 4.5-9kg (10-20#) depending on the wieght of the cleint.