NCLEX > Ortho > Flashcards

Ortho Flashcards

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1
Q

Fracture S/SX

A
  • pain and tenderness
  • unnatural movement
  • deformity (possible)
  • shortening of extremity (caused by muscle spasm)
  • crepitus (bones/cartilage grating together)
  • swelling
  • discoloration
  • WORRY about Compartment Syndrome
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2
Q

Fracture Treatment

A

Prevents further injury:
• immobilize the bone ends plus the adjacent joint
• support fx above and below site
• move extremity as little as possible

  • Splints help prevent fat emboli and muscle spasms
  • open fractures? cover w/ something STERILE
  • Do NEUROVASCULAR CHECKS (pulses, color, movement, sensation, cap refill, temp)
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3
Q

Fracture Complication:

SHOCK

A

Hypovolemic
• depends on amount of trauma and type of injury
• specifically w/ - pelvic, crushing, multiple long bone fractures

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4
Q

Fracture Complication:

FAT EMBOLISM

A

• seen w/ long bones (femur), pelvic, crushing fractures
• s/sx depend on where the fat emboli goes
• s/sx
- petechiae or rash over chest
- conjunctival hemorrhages
- snow storm on CXR “patchy infiltrates”

Misc info:
• young males - risky behavior
• 1st 36 hrs - after injury

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5
Q

Fracture Complication:

COMPARTMENT SYNDROME

A
  • Increased pressure w/i a limited space
  • common in circumferential burns, carpal tunnel syndrome, cellulitis, injured arm w/o fx

• Pathophysio
- Fluid accumulates in the tissue and impairs tissue perfusion
- The muscle becomes swollen and hard and the client reports severe pain that is not relieved w/ pain meds
• The pain is disproportionate to the injury
• common areas - forearms and quadriceps

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6
Q

if Compartment Syndrome undetected, may result in?

Manifestations to look for?

A

• nerve damage and possible amputation
*ischemia occur within 4-8 hrs after onset

• Manifestations (1 or more present)

  • Pain
  • Pressure
  • Paresthesia
  • Pallor
  • Paralysis
  • Pulseless
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7
Q

Compartment Syndrome Treatment

A
  • If they have cast, loosen the cast to restore circulation
  • “remove cast” should not be 1st choice!! be careful!
  • Cast cutters to remove or loosen the cast
  • Cast saws - not like regular saw; does not touch skin, but it vibrates
  • Fasciotomy - the PHP cuts down into the tissue to relieve pressure and restore circulation
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8
Q

Plaster Casts care

A
  • place ice packs on the side of cast for 1st 24 hrs b/c cast is still wet (coolness ↓ edema)
  • Prevent indentations - can cause pressure sore
  • keep cast uncovered and allow for air dry
  • do not rest on a hard surface or sharp edge
  • rest cast on a soft pillow; NO PLASTIC
  • mark breakthrough bleeding – circle area; date and time site
  • cover cast close to groin w/ plastic (once cast is dry)
  • Neurovascular w/ 5 P’s
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9
Q

(Plaster Casts care)
Use palms of hands for first ____ hours
Do not use ____

A
  • 24 to 72 hours

* fingertips

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10
Q

Lower extremity injuries with delayed healing–what to ask?

A

Ask client if they’re diabetic

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11
Q

(Plaster Casts care)

What do you do if your client reports of pain?

A

Neurovascular checks

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12
Q

(Plaster Casts care)

Most pain is relieved by elevation, cold packs, and analgesics–if these things do not relieve pain…think ____

A

COMPLICATION like Compartment Syndrome

Assume the worst!

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13
Q

Fiberglass Cast

A
  • Dry within 30 minutes
  • used for simple fx
  • Advantages: Lightweight, waterproof, stronger than plaster casts
  • X-ray imaging is a higher quality w/ fiberglass casts
  • allow the client to bear weight earlier
  • Disadvantages: difficult to mold and contour
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14
Q

Do not stick anything down your cast. True or False?

A

True

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15
Q

What to use for cast itching?

A

Use blow dryer on cool setting or diversional activity

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16
Q

Traction

A
  • Uses a pulling force to reduce and immobilize fractures
  • Goal: Reduce muscle spasms, pain, realign bones and prevent deformities
  • should be CONTINUOUS
  • Weights should hang FREELY
  • Keep client pulled up in bed and centered with good alignment
  • Exercise the non-immobilized joints
  • Ropes should move FREELY and knots should be SECURED
  • Weights should not rest on bed or floor
  • Special mattress overlays such as air-filled or high-density foam mattresses can be used
  • Prevent foot drop, a foot drop BOOT (or high top sneakers)
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17
Q

Should skeletal traction be intermittent or continuous?

A

CONTINUOUS

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18
Q

(skeletal traction)

Weights should hang ____ and not rest on _____

A

freely; bed or floor

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19
Q

(skeletal traction)

Ropes should move ____ and knots should be _____

A

freely, secured

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20
Q

(skeletal traction)

Never release traction (unless you’ve got a PHP’s prescription)–Releasing traction will cause what?

A
  • Pain
  • Muscle spasm
  • Bone displacement
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21
Q

Skin traction

A
  • used short term to relieve muscle spasm and immobilize until surgery
  • a tape, a boot, splint, or some type of material is applied directly to skin and weights pull against it
  • Skin is NOT penetrated
  • Buck’s traction (common type–used w/ hip and femoral fx)
  • Must do good skin assessments 3x a day *ankle and achilles tendon area
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22
Q

(Skin traction)

Is the skin penetrated?

A

No

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23
Q

Common type of skin traction?

A

Buck’s traction

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24
Q

(Traction care)

Client is pulled down on the bed, the weights are almost touching the floor–what to do?

A

Ask some people to help you.

Have people pull up a client in bed and centered with good alignment while you LIFT the traction.

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25
Skeletal traction
* traction is applied directly to the bone w/ pins and wires (to immobilize leg) * used when prolonged traction is needed * types - Steinman pins, Crutchfield, Gardner - Wells tongs, Halo vest * Monitor pin sites q8h (for inflammation/infection sx) * Pin care begins 48 - 72 hrs after insertion and perform daily using STERILE technique, serous drainage is okay
26
(Skeletal traction) | How often should you monitor the pin sites
Every 8 HOURS
27
(Skeletal traction) | Pin care begins when?
48 to 72 hours after insertion
28
(Skeletal traction pin care) Sterile technique used? ____ Is serous drainage okay? ____
Yes, Yes
29
Client with Steinman pins in their leg. During assessment, you notice that one of the pins has fallen out and is lying on the bed. What to do? 1. Reinsert 2. Cover the opening 3. Immobilize their leg 4. Call the PHP
3. Immobilize their leg | - - this is the purpose of the Steinman pins
30
Clients w/ orthopedic/joint problems require a (soft or firm) mattress for support.
FIRM
31
Total hip replacement Pre-op care: | What type of traction is used frequently pre-op to immobilize the fracture?
Buck's traction (skin traction)
32
Total hip replacement Post-op care
• Neurovascular checks • Monitor drains (don't want fluid to accumulate in the tissues • FIRM mattress (joints need support) • over bed trapeze to build UPPER body strength • Positioning - want NEUTRAL rotation - toes pointed to the ceiling - limit flexion; want EXTENSION of hip - ABDUCTION - legs apart (prevent dislocation) • Exercise when client still confined to bed - isometric (squeezing quads/glutes) • Trochanter roll to prevent EXTERNAL rotation, document in nurse's notes • No weight bearing • Avoid crossing legs or bending over • Do NOT sleep on operated side • HYDRATION is important! • NOT okay to give pain meds in the operative hip
33
Proper positioning after total hip replacement?
- want NEUTRAL rotation - toes pointed to the ceiling - limit flexion; want EXTENSION of hip - ABDUCTION - legs apart (prevent dislocation)
34
What exercise can the client do while still confined to bed?
isometric (squeezing quads/glutes)
35
What is the purpose of the trochanter roll?
prevent EXTERNAL rotation, document in nurse's notes
36
Total hip replacement Complications | DISLOCATION
``` • circulatory and nerve damage • S/SX - shortening of leg - abnormal rotation - can't move extremity - pain ```
37
Total hip replacement Complications | INFECTION
* Give prophylactic antibiotics | * Remove indwelling catheters and drains ASAP--these will sere as a portal for INFECTION
38
Total hip replacement Complications | AVASCULAR NECROSIS
death of tissue d/t poor circulation
39
Total hip replacement Complications | IMMOBILITY PROBLEMS
* skin breakdown, pressure ulcers * contractures, muscular weakness, muscular atrophy, disuse osteoporosis * renal calculi, urinary stasis, urinary retention, urinary incontinence, UTI * atelectasis, pneumonia, decreased respiratory vital capacity * venous stasis, venous insufficiency, orthostatic hypotension, decreased cardiac reserve, edema, emboli, thrombophlebitis * constipation * loss of calcium from the bones
40
Total hip replacement Client Education/Rehabilitation
* Best exercises - walking, swimming, rocking in a rocking chair -- when PCP says it's okay! * AVOID FLEXION - low chairs - traveling long distances - sitting >30 mins - lifting heavy objects - excessive bending or twisting - stair climbing
41
Best exercises for clients who had total hip replacement?
walking, swimming, rocking in a rocking chair -- when PCP says it's okay!
42
Amputations
* Performed at the most DISTAL pint that will heal | * Surgeon tries to preserve the KNEE or ELBOW
43
In amputations, what parts of the body does the surgeon try to preserve?
KNEE or ELBOW
44
Amputations: Immediate Post-op Care
* Keep TOURNIQUET at the bedside (massive hemorrhage) * Prevent hip/knee contractures by EXTENSION * Inspect residual limb daily to be sure that it lies completely FLAT on the bed * PRONE position to extend hip or knee joints
45
(amputations) | keep what at bedside in case of massive hemorrhage?
tourniquet
46
Prevent hip/knee contractures. How?
Extension
47
What position would extend the hip or knee joints?
Prone
48
above-knee amputation position?
Prone
49
below-knee amputation position?
Supine
50
Phantom pain
* client feel like limb is still there existing * seen more w/ AKA's (above the knee amputations) * usually subsides in 3 months
51
What is the first intervention to decrease phantom pain?
Diversional activity, then pain medication - gabapentin (Neurontin) [treat neuropathic pain (nerve pain) ]
52
Definition of pain is what the client says it is. Other techniques or pain meds first?
Other techniques first prior to medication
53
Amputations: Rehabilitation
• Limb shaping important for the prosthesis • Stump shaped ROUND and small • Limb sock worn under the prosthesis • Strengthen the upper body to use crutches or a walker to ambulate • Massage stump to promote circulation and decrease tenderness • Toughen the stump soft pillow -> firm pillow -> bed -> chair
54
what are the 5 P's
``` Pain Paresthesia (numbness/tingling) Pallor (pale skin, coolness) Paralysis (can't move) Pulseless (diminished/absent) ```
55
(amputations) Why is limb shaping important? How do you want the stump shaped at the end?
for prosthesis | round and small
56
(amputations) | What is worn under the prosthesis?
``` limb sock (to shape) *post-op compression to decrease bleeding and edema ```
57
(amputations) | Why is it important to strengthen the upper body?
They will be using crutches or a walker to ambulate
58
(amputations) Is it okay to massage the stump? Why or why not?
Yes. Massaging promotes circulation and decreases tenderness
59
(amputations) | How do you teach a client to toughen the stump?
• Press into a soft pillow -> firm pillow -> bed -> chair
60
Always assess the client's pain by?
Having them rate their pain on a pain scale (i.e., 0-10)
61
``` Crutches • how many inches below armpit? • how to go upstairs and downstairs? • 3 point crutch walking? • 4 point crutch walking? ```
• 1 - 1 ½ inches below armpit • "good goes to heaven, bad goes to hell" going up - good foot first w/ injured foot raised behind; going down - hold injured foot up in front, hop down on good foot • 3 point - bear weight on uninjured foot and both crutches; affected leg does NOT touch ground • 4 point - bear weight on both legs and both crutches----each leg moved in sequence w/ opposite crutch---right leg w/ left crutch OR left leg and right crutch
62
Canes • top of cane should reach to the ____ in client's wrist when client is standing up straight • elbow should ____ a bit when client holds the cane * COAL? * how to walk w/ cane? * how to climb stairs? * how to come DOWN stairs
* CREASE * elbown BEND a bit * Cane Opposite Affected Leg * walking--cane and injured leg swing and strike the ground at the same time * climb upstairs - grasp on handrail--step up on good leg first w/ cane in hand opposite the injured leg--step up on injured leg * going downstairs--put cane on step first, then injured leg, then good leg (carry body wt)
63
``` Walkers • use ____ to support some of the weight • how to use? • to sit? • to get up from a chair? • NEVER's with a walker? ```
* Use ARMS to support some of the weight * put walker one step ahead → w/ both hands, grip top of walker for support and walk into it → stepping off on your injured leg → touch heel of this foot to ground first → then flatten foot → fianlly lift toes off the ground as client makes a complete step w/ good leg * to sit----client should back up until his/her legs touch the chair →reach back to feel the seat before → sit down * to get up from a chair---client should push himself/herself up → grasp walker's grips * NEVER try to climb stairs or use an escalator!!!!
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