Amps/Joint surg/Herniated Disks - 405

Question 1

who is a candidate for an amputation

Answer 1

-PVD (esp w/ DM)
-trauma
-thermal injuries
-osteomyelitis
-tumors
-congenital limb disorders

Question 2

types of amputations

Answer 2

1) open vs closed
2) elective vs traumatic

Question 3

open (guillotine) amputation

Answer 3

leaves the wound bed open
-used for someone with an infected area where they don’t want to close it yet
needs to be aseptic before closure

Question 4

closed amputation

Answer 4

edges of wound bed are approximated right after surgery

Question 5

complications of amputations

Answer 5

-hemorrhage
-infection
-phantom limb pain
-flexion contractures (esp at hip)

Question 6

phantom limb pain mgt

Answer 6

-usually self limiting within a year
-mirror therapy
-neuropathic analgesics

Question 7

post op care & pt teaching for an amputation

Answer 7

-assess tissue perfusion
-pain mgt (ATC dosing)
-prevent infection
-promote proper position/ambulation/PA
-initially compression bandage to foster shaping & molding (take off for PT & baths) then figure 8 wrapping to prevent restricted blood flow)
-psychosocial issues
-prosthesis (consult prosthetist-orthotist)

Question 8

proper positioning for a post op amputee pt

Answer 8

-prone position 30 min 4x/d (extends the hip)
-elevate stump based on provider preference (does cause concern for flexion @ hip)

Question 9

bone on bone in the spinal column (ex: degenerative disc disease in lumbar area) get what

Answer 9

sciatic pain

Question 10

what is the spinous process

Answer 10

C7

Question 11

how to dx problems with the spinal discs

Answer 11

-MRI: no metal, non invasive, sedation prn d/t claustro
-CT scan
-myelogram: x ray after injection of contrast into subarachnoid space, sedate prn, done on tilt table, encourage fluids after

Question 12

collaborative care fro pt w/ suspected disk herniation

Answer 12

-brace/corset/belt
-local heat/ice
-massage
-traction
-TENS
-NSAIDs/short term narcotics/muscle relaxants
-back strengthening exercise
trying to avoid surgery

Question 13

laminectomy

Answer 13

excision of lamina (posterior arch of vertebra) to gain access to protruding disk to remove it

Question 14

diskectomy

Answer 14

decompresses the nerve root
minimally invasive

Question 15

spinal fusion

Answer 15

add bone graft/synthetic product for stabilization & so the bone isn’t sitting on another bone

Question 16

nursing implications post spinal procedure

Answer 16

-lie flat / avoid twisting
-log rolling
-pain mgt
-monitor for HA and clear yellow drainage d/t risk for CSF leak
-peripheral neurovascular checks
-spinal fusion recovery longer + monitor donor site
-avoid sitting/standing for long periods of time

Question 17

why do people have to have joint surgeries

Answer 17

-relieve pain
-improve joint motion
-correct deformity & mal-alignment
-remove intra-articular causes of erosion

Question 18

arthroplasty

Answer 18

reconstruction of replacement of joint

Question 19

who gets a joint surgery

Answer 19

-osteoarthritis
-rheumatoid arthritis
-congenital deformities

Question 20

what joints can an arthroplasty be done on

Answer 20

-elbow&shoulder
-wrist&phalangeal joints of finger
-hip
-knee
-ankle
-foot

Question 21

total joint arthroplasty related nursing problems

Answer 21

-acute pain
-impaired physical mobility
-risk for peripheral NV dysfunction
-risk for injury
-risk for impaired skin integrity
-possible VTE

Question 22

post op total knee replacement goals

Answer 22

restore strength, muscle tone & ROM (will be given exercises to do and if can’t will have a machine to move leg for them)

Question 23

total hip (& knee) arthroplasty post op care

Answer 23

-neurovascular assessment of affected extremity
-original surgical dressing to be removed by surgeon
-maintain specific ROM limitations

Question 24

post op hip replacement limitations: posterior approach

Answer 24

avoid the following for at least 6 weeks
-extreme internal rotation
-adduction
->90 flexion
-elevate toilet seat

Question 25

post op hip replacement limitations: anterior approach

Answer 25

hyperextension is the only restriction

Question 26

post op limitations for pts who fractured their hips and had an open reduction internal fixation

Answer 26

limit weight bearing for 6-12 wks

Question 27

non weight bearing (NWB)

Answer 27

affected extremity should not touch floor

Question 28

toe touch weight bearing (TTWB)

Answer 28

affected foot may rest on floor for balance but no bearing of weight

Question 29

partial weight bearing (PWB)

Answer 29

can bear 30-50% of weight on affected extremity

Question 30

weight bearing as tolerated (WBAT)

Answer 30

as much as can tolerate without undue strain or pain

Question 31

what helps prevent muscle atrophy

Answer 31

isotonic movements -> contract & release muscle but joint doesn’t move

Question 32

post op ORIF s/p hip fracture to restore strength, muscle tone & ROM

Answer 32

-quadriceps setting
-gluteal muscle setting
-leg raises in supine & prone position
-lef abduction exercises