Amputation, Joint Surgery, Osteomyelitis, Osteoperosis

Question 0

What is the difference between a Closed and and Open Amputation?

Answer 0

1) Closed - Creates a weight-bearing residual limb (stump), skin flap cover the stump, suture line not in area of weight bearing and skin is folded firmly as to not allow fluid accumulation and thus infection.
2) Open - Leaves a surface not covered by skin fold, is closed at a later time, and is used for actual or potential infections.

Question 1

Prior to amputation, what are the 6 SxS of Peripheral Vascular Disease?

Answer 1

1) Skin feels cool
2) Ulcers
3) Lack of perfusion
4) Hair loss
5) ⬇ Pain sensation
6) Faint pulses

Question 2

Why should you avoid flexion after an amputation?

Answer 2

Because flexion can lead to contractures

Question 3

What are the 4 benefits of proper bandaging after amputation?

Answer 3

1) Stump shaping and molding
2) Supports soft tissue
3) Reduces edema and pain
4) Promotes limb shrinkage, healing, and maturation

Question 4

What are the 3 benefits to immediate prosthesis fitting after amputation?

Answer 4

1) Gradually increases WBAT
2) Promotes early ambulation
3) Psychological benefits

Question 5

What are the 3 complications associated with amputation?

Answer 5

1) Grieving
2) Phantom limb pain
3) Flexion contractures

Question 6

What are the 4 “Do Nots” we should teach out patient and their family after an amputation?

Answer 6

1) DO NOT use lotions, alcohol or powders.
2) DO NOT sit for > 1 hour
3) DO NOT flex the hips b/c it could lead to contractures.
4) DO NOT elevate limb too high. Use only 1 pillow and only for the 1st 24 hours.
* Elevating the limb minimizes edema.

Question 7

What are the 6 “Dos” we should teach out patient and their family after an amputation?

Answer 7

1) DO inspect for infection and prosthesis irritation
2) DO wash w/warm water and bacterial static soap and exposé to air for 20 mins.
3) DO wear only residual limb sock (elastic compression dressing/wrap and Shrinker).
4) DO perform ROM
5) DO lay prone for 30 mins TID
6) DO prepare for the prosthesis by pushing the limb against pillows and progressing to firmer surfaces.

Question 8

What are the 3 characteristics of Intracapsular hip fractures?

Answer 8

1) Includes capital (head), subcapital (below the head), transervical (neck).
2) Associated with osteoperosis and minor trauma
3) Most difficult to heal d/t decreased blood supply

Question 9

What are the 2 characteristics of Extracapsular hip fractures?

Answer 9

1) Includes intertrochanteric and subtrochanteric

2) Caused by severe direct trauma or a fall

Question 10

(T/F) The Anterior approach has a easier recovery than the Posterior approach for hip surgery and no precautions are necessary.

Answer 10

True

Question 11

What are the 6 DO NOTS postop for a patient that had hip surgery via the Posterior approach?

Answer 11

1) No adduction (toward the midline) and do not cross legs
2) No flexing hip > 90 degrees
3) No internal rotation
4) No bending at the waist
5) No twisting to reach behind
6) No driving or tub baths for 4-6 weeks

Question 12

What are the Dos and Don’ts to teach the patient who is postop for a TKA (Total Knee Arthroplasty) or a PKA (Partial knee Arthroplasty)?

Answer 12

1) Do immobilize in full extension for 4 weeks
2) Do use CPM for 8hrs/24hrs
3) Do not elevate on pillows because this can lead to contractures.

Question 13

What is the goal of CPM (Continuous Passive Motion)?

Answer 13

90 degrees flexion

Question 14

Why must the Femoral Nerve Block be turned of at least 1 hr before activity?

Answer 14

Because it weakens the quads and makes the patient lose sensation as well. (Risk for fall)

Question 15

What are the 4 listed causes of chronic low back pain?

Answer 15

1) Degenerative disk disease
2) Lack of physical exercise
3) Prior injury
4) Obesity

Question 16

When is surgery indicated for chronic low back pain?

Answer 16

1) When diagnostic tests indicate problem is not responding to at least 4 weeks of conservative therapy.
2) When the patient is in consistent pain
3) When there is a persistent Neurologic deficit

Question 17

What is the clinical manifestations of intervertebral lumbar disk damage when it is between L3 and L4? List the following:

1) Subjective pain
2) Affected reflex
3) Motor function
4) Sensation

Answer 17

1) Subjective pain - Back to buttocks to posterior thigh to inner calf
2) Affected reflex - Patellar
3) Motor function - Quadriceps and anterior tibialias
4) Sensation - Inner aspect of lower leg and anterior part of thigh

Question 18

What is the clinical manifestations of intervertebral lumbar disk damage when it is between L4 and L5? List the following:

1) Subjective pain
2) Affected reflex
3) Motor function
4) Sensation

Answer 18

1) Subjective pain - Back to buttocks to dorsum of foot and big toe
2) Affected reflex - None
3) Motor function - Anterior tibialias, extensor hallucis longus, gluteus medius
4) Sensation - Dorsum of foot and big toe

Question 19

What is the clinical manifestations of intervertebral lumbar disk damage when it is between L5 and S1? List the following:

1) Subjective pain
2) Affected reflex
3) Motor function
4) Sensation

Answer 19

1) Subjective pain - Back of buttocks to sole of foot and heel
2) Affected reflex - Achilles
3) Motor function - Gastrocnemius, hamstring, gluteus maximus
4) Sensation - Heel and lateral foot

Question 20

What are the 4 characteristics of a Laminectomy?

Answer 20

1) Traditional and most common
2) Surgical excision to gain access to and remove entire lamina
4) Takes pressure off the nerve
5) Minimal hospital stay is usually required

Question 21

What are the 3 characteristics of a Laminotomy?

Answer 21

1) Removes a portion of the lamina
2) Relieves pressure on nerve
3) Minimal hospital stay is usually required

Question 22

What are the 4 characteristics of Charite Disk?

Answer 22

1) Done to treat Disk damage associated DDD
2) Artificial disk sandwiched between two cobalt chromium end plates
3) Surgically placed in spine through small incision below umbilicus after damaged disk is removed
4) Allows for movement at level of implant

Question 23

Describe a spinal fusion, when is done, and what therapeutic effect does it provide?

Answer 23

• The spine is stabilized by creating ankylosis (fusion) of continuous vertebrae with either a bone graft from the patient’s fibula or iliac crest, cadaver bone, or artificial sources such as bone morphogenic protein (BMP)
• Spinal fusion is done when unstable bony mechanism is present
• Spinal fusion provides stability and decreases vertebral motion from pressing on nerves

Question 24

What are the 8 things to keep in mind when caring for a patient postop for spinal surgery?

Answer 24

1) Maintain proper alignment of the spine (logroll patient)
2) Bed rest may be maintained for 1-2 days
3) Ambulation may begin the day after surgery
4) Use pillows under thighs when supine and between legs when side-laying
5) Monitor peripheral neurological signs of extremities every 2-4 hours for the first 48 hours.
6) Movement and sensation of arms and legs should be unchanged from preop status
7) No anticoagulants, they can cause peri-spinal hematomas which can lead to spinal cord injury
8) Monitor for CSF leaks (headaches when the patient stands)

Question 25

(T/F) Patients who are postop for spinal surgery should avoid sitting for for prolonged periods of time.

Answer 25

True - no longer than 20-30 mins

Question 26

What is Osteomyelitis?

Answer 26

Osteomyelitis is a severe infection of the bone, bone marrow and/or surrounding soft tissues caused most commonly by S. aureus.

Question 27

Define Acute Osteomyelitis?

Answer 27

The Initial Infection of Osteomyelitis. usually < 1 month in duration and is seen both systemically and locally.

Question 28

What are the 5 systemic symptoms of Acute Osteomyelitis?

Answer 28

1) Fever
2) Night sweats
3) Chills
4) Restlessness
5) Nausea

Question 29

What are the 3 local symptoms of Acute Osteomyelitis?

Answer 29

1) Constant bone pain that is unrelieved by rest and worsens with activity
2) swelling, tenderness and warmth at site
3) Restricted movement

Question 30

What are the 4 characteristics of Chronic Osteomyelitis?

Answer 30

1) Bone infection > 1 month
2) Infection that has failed to respond to initial course of antibiotic therapy
3) Systemic signs may be diminished because the body has compensated
4) Local signs of infection are more common

Question 31

What are the two methods of contracting Osteomyelitis?

Answer 31

1) Direct - From and open wound or surgery

2) Indirect - Blood borne

Question 32

How are antibiotics usually delivered to patients with osteomyelitis and for how long is it usually administered?

Answer 32

1) delivered via CVC or PICC

2) Usually continued at home for 4-6 wks but can be as long as 3-6 months

Question 33

What are the 6 antibiotics prescribed for osteomyelitis?

Answer 33

1) Penicillin, nadcillin (Nafcil)
2) Neomycin
3) Vancomycin
4) Cephalexin (Keflex)
5) Cefazolin (Ancef) this one can penetrate the bone and is administered to bone surgery patients
6) Gentamicin (Garamycin) - watch for hearing problems

Question 34

What is Osteoperosis?

Answer 34

Osteoperosis is a chronic metabolic bone disease characterized by

1) Porous bone
2) Low bone mass
3) Structural deterioration of bone tissue
4) Increased bone fragility

Question 35

List the 13 risk factors associated with Osteoperosis

Answer 35

1) Female gender
2) Old age
3) Family Hx
4) White or Asian ethnicity
5) Small stature
6) Early menopause
7) Excess alcohol intake
8) Smoking
9) Anorexia
10) Oophorectomy
11) Sedentary lifestyle
12) Insufficient calcium or Vitamin D intake
13) Low testosterone levels in men

Question 36

What are the 5 clinical manifestations of Osteoperosis?

Answer 36

1) Sudden strain
2) Fractures
3) Back pain
4) Loss of height
5) Spinal deformities because of kyphosis (aka dowager’s hump)

Question 37

What are the 7 good food sources of calcium discussed in class?

Answer 37

1) Milk
2) Yogurt
3) Turnip greens
4) Spinach
5) Cottage cheese
6) Ice cream
7) Sardines

Question 38

What are the 7 poor food sources of calcium discussed in class?

Answer 38

1) Eggs
2) Beef
3) Cream cheese
4) Poultry
5) Pork
6) Apples and bananas
7) Potatoes and carrots

Question 39

What are the 3 methods that were discussed to manage Osteoperosis?

Answer 39

1) Take supplemental vitamin D and calcium
2) Encourage exercise to build up and maintain bone mass
3) Instruct patients to quit smoking and ⬇ alcohol intake to ⬇ losing bone mass

Question 40

What are the 6 types of drugs that were discussed that interfere with calcium metabolism?

Answer 40

1) Corticosteroids
2) Anti-seizure meds
3) Aluminum-containing antacids
4) Heparin
5) Excessive PTH
6) Certain cancer drugs

Question 41

What kind of drugs are used to manage Osteoperosis?

Answer 41

Biphosphonates - i.e., Alendronate (Flomax), Risendronate (Evista), and Ibandronate (Boniva).

Question 42

What instructions should you give a patient who is taking Biphosphonates for Osteoperosis?

Answer 42

1) Take in the morning before eating or drinking
2) Take with a full glass of water
3) Stand or sit upright for 30-60 mins after taking Ibandronate and do not eat or drink during this time because that may cause esophagitis, muscle pain, or ocular problems.

Question 43

Why won’t X-rays detect early Osteoperosis?

Answer 43

Because Osteoperosis may be undetectable on routine X-rays until there has been 25-40% demineralization, resulting in radiolucency of the bones.

Question 44

Define DEXA, what is it used to diagnose?

Answer 44

DEXA is a dual energy X-ray absorbtiometry used to analyze the BMD at the hip and spine to diagnose Osteoperosis.

Question 45

Selective Estrogen Receptor Modulators (SERMs) reduce the risk of Osteoperosis by preserving BMD without estrogen if effects on the uterus. What is the only SERM drug approved for Osteoperosis in post menopausal women?

Answer 45

Raloxifene - Does not ⬆ the risk of breast or uterine cancer but but it does come with an increased risk of thromboembolism.

Question 46

What is the relationship between PTH and Calcitonin?

Answer 46

1) PTH (⬆ Ca in the blood) is released by the Parathyroid hormone when serum Ca is low.
2) Calcitonin (⬇ Ca in the blood) is released by the Parathyroid hormone when serum Ca is high.

Question 47

Patients with IBD are at significantly increased risk for which disease?

Answer 47

Osteoperosis