Exam 4 - Mod 14 (Ch.65,66,67,68) Flashcards
1
Q
Purpose of the Musculoskeletal system? (4)
A
*Protect body organs
*Provide support and stability
*Store minerals
*Allow coordinated movement
2
Q
Connective tissue composes what parts of the musculoskeletal system? (6)
A
*Bone
*Cartilage
*Ligaments
*Tendons
*Fascia
*Bursae
3
Q
Connective tissue responsible for what?
A
support and structure
4
Q
Voluntary muscle responsible for what?
A
movement - we consciously control
5
Q
How many bones in human body?
A
206 bones
6
Q
Name 5 bone types
A
Long, Short, Flat, Irregular, Sesamoid
7
Q
Characteristics of long bones
A
Longer then they are wide, with shaft and two enlarged ends
8
Q
example of a long bone
A
femur (thigh bone) & humerus (upper arm bone)
9
Q
Characteristics of a short bone
A
cubed shape - similar width and length
10
Q
example of a short bone
A
Carpals (wrist bones) and tarsals (ankle bones)
11
Q
Characteristics of flat bones
A
thin and often curved, provides protection or surface area for muscle attachment
12
Q
example of a flat bone
A
skull bones, ribs, sternum
13
Q
Characteristics of Irregular bones
A
Complex shapes don’t fit into other categories
14
Q
Example of a irregular bone
A
vertebrae (bone of the spine), some facial bones
15
Q
Goal of a musculoskeletal system assessment
A
Overall looking for muscle atrophy and symmetry
16
Q
What testing would be used to obtain objective data during a musculoskeletal system assessment?
A
Physical exam: Muscle-strength testing
17
Q
Muscle strength testing is graded on a 0-5 scale what does 0 mean?
A
0 - No muscle contraction: Complete paralysis.
18
Q
Muscle strength testing is graded on a 0-5 scale what does 1 mean?
A
1 - Trace contraction: Slight contraction visible or palpable, but no movement.
19
Q
Muscle strength testing is graded on a 0-5 scale what does 2 mean?
A
2 - Poor contraction: Full range of motion with gravity eliminated (e.g., limb can move if supported).
20
Q
Muscle strength testing is graded on a 0-5 scale what does 3 mean?
A
3 - Fair contraction: Full range of motion against gravity, but not against resistance.
21
Q
Muscle strength testing is graded on a 0-5 scale what does 4 mean?
A
4 - Good contraction: Full range of motion against gravity and some resistance.
22
Q
Muscle strength testing is graded on a 0-5 scale what does 5 mean?
A
5 - Normal contraction: Full range of motion against gravity and full resistance.
23
Q
Nurse identifies muscle weakness completing a skeletal system assessment, what could this indicate?
A
Neurological issues such as nerve damage or muscle disorders
24
Q
Why would a functional ability be addressed when completing a musculoskeletal system assessment?
A
Muscle strength is directly related to a person’s ability to perform daily activities
25
Why address musculoskeletal injury when completing a musculoskeletal system assessment?
To help assess the severity of injuries like muscle strains or tears.
26
Why would circumferential muscle mass be measuresed during a musculoskeletal system assessment?
27
Why would limb length be measured during a musculoskeletal system assessment?
To identify any discrepancies, which can indicate developmental issues, injuries, or deformities.
28
Why would the nurse assess a patients posture and gait?
To observe their alignment of the body (posture) and manner of walking (gait) for any abnormalities
*Look for scoliosis
29
Why should the nurse clarify if patient uses assistive devices like canes, crutches, walkers or other devices?
Indicates potential functional limitations
30
Why should patient perform a straight leg raise during a musculoskeletal system assessment?
*To assess for lumbar nerve root irritation, often associated with herniated discs
*Also helps assess neurological involvement
31
Why is an assessment of the musculoskeletal system so important?
*Identifies musculoskeletal issues
*Guides treatment
*Monitoring progress
31
What would be included in a musculoskeletal system functional assessment and why? (3)
*Assesses posture, gait, and the use of assistive devices.
*Provides insights into the patients functional abilities.
32
Define scoliosis
A lateral curvature of the spine
33
Diagnostic studies of musculoskeletal system? (5)
*Standard x-ray - most common
*Bone scan
*Computed tomography (CT) scan
*Diskogram
*Dual energy x-ray absorptiometry (DEXA)
34
Purpose of an x-ray
Uses radiation to create images of bones and joints.
35
Relating to the musculoskeletal system, why would patient get an Xray, to detect what? (5)
*Detects fractures
*Dislocations
*Bone abnormalities
*Arthritis
*Other bone-related conditions.
36
An advantage of Xray? (3)
*Widely available
*Relatively inexpensive
*Provides a quick overview of bone structures.
37
Purpose of bone scan?
Uses a radioactive tracer to visualize bone metabolism and identify areas of increased bone activity
38
What can a bone scan detect? (4)
Detects fractures (especially stress fractures), infections, tumors, and metabolic bone diseases.
39
Advantage of a bone scan?
More sensitive than X-rays for detecting subtle bone changes.
40
what does 'CT' scan stand for?
Computed Tomography
41
Purpose of a Computed Tomography Scan?
Uses X-rays and computer processing to create detailed cross-sectional images of bones and soft tissues.
42
Relating to the musculoskeletal system, what can a CT scan detect? (4)
Provides detailed images of complex fractures, bone tumors, infections, and spinal abnormalities.
43
Advantage of a CT scan?
Offers better visualization of soft tissues compared to X-rays.
44
Purpose of a diskogram?
Involves injecting contrast dye into an intervertebral disc and taking X-rays to visualize the disc's structure.
45
What can a diskogram detect? (4)
Evaluates disc abnormalities, such as herniation or degeneration, and helps determine the source of back pain.
46
Advantage of a diskogram? (2)
Provides detailed images of the disc and can help identify specific disc-related problems.
47
Purpose of a dual energy X-ray absorptiometry (DEXA)?
Uses low-dose X-rays to measure bone mineral density
48
What could a dual energy X-ray absorptiometry (DEXA) detect? (2)
Diagnoses osteoporosis and assesses fracture risk.
49
Advantage of DEXA?
Considered the gold standard for measuring bone mineral density.
50
What do you review with patient before they get a diagnostic study with CONTRAST?
Check for
*Allergies
*Renal function
*Metformin
51
Purpose of an electromyogram (EMG)?
Measures the electrical activity of muscles
52
Relating to the musculoskeletal system, what can an EMG diagnostic study detect? (5)
Detects muscle and nerve dysfunction, such as muscular dystrophy, nerve compression, or peripheral neuropathy.
53
How is an EMG diagnostic study completed?
Needles are inserted into muscles to record electrical signals during muscle contraction and relaxation.
54
Define MRI?
Magnetic Resonance Imaging
55
Purpose of MRI? (5)
Uses strong magnetic fields and radio waves to create detailed images of bones, joints, muscles, ligaments, and tendons
56
Relating to the musculoskeletal system, what could an MRI detect? (4)
Evaluates soft tissue injuries, joint abnormalities, spinal cord problems, and bone tumors.
57
Define EMG?
Electromyogram
58
Advantage of MRI?
Provides excellent soft tissue detail without using radiation.
59
Purpose of Myelogram with or without CT?
Uses contrast dye injected into the spinal canal followed by X-rays or CT scans to visualize the spinal cord and nerve roots.
60
Relating to the musculoskeletal system what can a Myelogram with or without CT detect? (4)
Detects spinal cord compression, herniated discs, spinal stenosis, and tumors.
61
How is a Myelogram with or without CT completed?
Dye is injected into the spinal canal, and images are taken to show the spinal cord and nerve roots.
62
Define SSEP
Somatosensory Evoked Potential
63
Purpose of a SSEP?
Measures the electrical activity of the nervous system in response to stimulation of peripheral nerves.
64
Relating to the musculoskeletal system what can a SSEP detect?
Evaluates nerve function in the spinal cord and brain, often used during spinal surgery.
65
How is a SSEP completed?
Electrical impulses are delivered to peripheral nerves, and the resulting electrical activity is recorded from the brain or spinal cord.
66
Purpose of a thermography?
Uses infrared imaging to detect temperature variations on the skin's surface
67
Relating to the musculoskeletal system, what can a thermography detect?
Identifies areas of inflammation or nerve dysfunction, but less commonly used due to limitations
68
How is a thermography completed?
Measures skin temperature to detect areas of increased or decreased blood flow.
69
Define QUS
Quantitative Ultrasound
70
Purpose of a QUS?
Uses ultrasound to assess bone density and structure.
71
Relating to the musculoskeletal system, what could a QUS detect? (2)
Screens for osteoporosis and assesses fracture risk.
72
Advantage of QUS? (2)
Non-invasive and radiation-free.
73
Define Interventional Studies
74
Purpose of Arthrocentesis?
Involves aspirating fluid from a joint using a needle.
75
Relating to the musculoskeletal system, what could arthrocentesis detect? (5)
Diagnoses joint infections, arthritis, and other joint conditions; also relieves pain and swelling.
76
How is an arthrocentesis completed?
A needle is inserted into the joint to withdraw fluid for analysis or therapeutic purposes. To dry out fluid?
77
Purpose of Arthroscopy
Involves inserting a small camera and instruments into a joint to visualize and treat joint problems.
78
Relating to the musculoskeletal system, what can an arthroscopy detect? (4)
Diagnoses and treats ligament tears, cartilage damage, and other joint conditions
79
How is an arthroscopy completed?
A small incision is made, and a camera and instruments are inserted into the joint.
80
Define DDD?
Degenerative Disc Disease
81
Cause of DDD
Results from a loss of fluid in the intervertebral discs with aging.
82
How does DDD affect your body? (3)
The discs lose their elasticity, flexibility, and shock-absorbing abilities.
83
What is the cause of a herniated disc?
Can result from degeneration with age, or repeated stress and trauma to the spine.
84
Mechanism of herniated disc
The spinal disc bulges outward between vertebrae.
85
Purpose of a spinal fusion?
Spine is stabilized by creating an ankylosis (fusion) of contiguous (adjacent) vertebrae
86
2 ways bone grafts are sourced?
Autograft and allograft
87
Define autograft
Uses bone graft from the patient's fibula or iliac crest
88
Define allograft
Uses bone graft from a donated cadaver bone
89
Why is a metal fixation added during a spial fusion?
Adds stability and decreases motion
90
What is the purpose of Bone Morphogenetic protein (BMP)?
Used to stimulate bone growth of the graft
91
What is key focus for nursing intervention following a patient's vertebral disc surgery?
Maintaining proper alignment of the spine
92
Post-op vertebral disc surgery, for patient comfort while laying SUPINE and to maintain alignment where should pillows be placed?
Place pillows under patients' thighs
93
Post-op vertebral disc surgery, for patient comfort while in a side laying position and to maintain alignment where should pillows be placed?
Place pillows between legs
94
Why should pillows be utilized when positioning a patient who recently underwent a vertebral disc surgery?
To provide comfort and ensure proper spinal alignment
95
Following a vertebral disc surgery, why should a patient's neurological status be continuously assessed?
Essential to detect any nerve damage or complications
96
what is included in a neurological assessment?
97
Why would patient have cervical spine precautions following vertebral disc surgery
Risk for spinal corda edema
98
What s/s would you look for potential spinal cord edema?
Respiratory distress
Worsening neurological condition of the upper extremities
99
Following a vertebral disc surgery, aside from the primary surgical site, what other location on the patient's body should be assessed?
Also regularly assess the bone graft donor site
100
S/S of cerebral spinal fluid leakage?
headache, muscle weakness, hypotension
101
Why is bowel or bladder incontinence a major red flag for the nurse following a vertebral disc surgery?
Sign there may be potential nerve damage
102
Bowel or bladder incontinence following a vertebral disc surgery, nurses' priority action?
Call the provider - requires immediate action
103
Patient underwent lumbar fusion; what steps would you take to adjust patient? (3)
*Pillows between knees and ankles then log roll.
*Request help from colleagues to roll patient to ensure spinal alignment, ideally 3 people.
104
Where should pillows be while patients lays SUPINE after lumbar fusion?
Pillows under thighs to help maintain spinal alignment
105
Where should pillows be while patient is side laying after lumbar fusion?
Pillow between legs
106
What moving technique will the nursing team utilize on patient who just underwent a lumbar fusion?
Log roll to change position
107
Why would the nursing team use the log roll technique on a patient who just underwent a lumbar fusion?
Used to minimize spinal movement and prevent injury
108
How long are opioids administered following a spinal surgery?
Opioids are typically administered for the initial 24 to 48 hours after surgery
109
Benefits of patient-controlled analgesia (PCA)?
Allows patients to self-administer pain medication within prescribed limits, provides more control over pain management
110
Why should pain intensity be continuously assessed?
To ensure pain management effectiveness which promote comfort and healing
111
Spinal surgery - Post-Op - What should be included in a peripheral neurological assessment? (3)
*Movement and sensation - report new weakness or paresthesia
*Complete every 2-4hrs during first 48hrs post-surgery
*Compare with Pre-Op status
112
What do you include when assessing post-op circulation?
TEMPURATURE, CAPILLARY REFILL, PULSES
113
Why is circulation assessed during post-op spinal surgery?
To ensure adequate blood flow
114
What brace is often given to post-Op spinal fusion patients and why?
*Rigid orthosis such as a, thoracolumbosacral orthosis (TLSO) or a chairback brace
*Used to provide support and stability to the spine during healing
115
What should be taught to patient regarding rigid orthosis braces?
*Educate patient on preferred method to apply and remove
*Educate to sleep on back or side - no saggy soft beds!
116
With cervical spine surgery, what brace would be given to the patient during post-Op healing?
Hard or soft collar to immobilize neck
117
What type of dressing is required at the bone graft donor site?
pressure dressing
118
Which bone graft donor site requires the patient undergo more frequent neurovascular assessments and why?
FIBULA
Why- To monitor blood flow and nerve function in the leg
119
Define primary injury
Results from direct physical trauma to the spinal cord due to blunt or penetrating trauma
*Primary can be made worse by secondary
120
Define Secondary Injury
Refers to the ongoing progressive damage that occurs after the primary injury. It causes further permanent damage and begins a few minutes after the injury, lasting for months.
121
Define a C4 Injury and what paralysis could result
Tetraplegia (quadriplegia), resulting in complete paralysis below the neck
122
Define a C6 Injury and what paralysis could result
Results in partial paralysis of hands and arms as well as the lower body.
123
Define a T6 Injury and what paralysis could result
Paraplegia, resulting in paralysis below the chest.
124
Define a L1 Injury and what paralysis could result
Paraplegia, resulting in paralysis below the waist
125
Define a compression fracture
These fractures can compress the spinal cord, leading to neurological deficits.
126
Tetraplegia vs. Paraplegia
Tetraplegia affects all four limbs, while paraplegia affects only the lower limbs.
127
Define fracture
A fracture is a disruption or break in the continuity of bone
128
Define closed fracture
No break in the skin
129
Grade I open or compound/complex wound
1cm long clean wound
130
Grade II open or compound/complex wound
Larger wound w/o extensive damage
131
Grade III open or compound/complex wound
Highly contaminated, extensive soft tissue injury, may have amputation
132
Define a transverse fracture
The fracture line is perpendicular to the long axis of the bone
133
Define a spiral fracture
The fracture line spirals around the bone, often caused by a twisting injury
134
Define greenstick fracture
An incomplete fracture where the bone is bent but not completely broken. This is more common in children due to their softer bones
135
Define comminuted fracture
The bone is broken into multiple fragments.
136
Define oblique fracture
The fracture line is at an angle to the long axis of the bone.
137
Define pathologic fracture
A fracture that occurs in a bone weakened by disease (e.g., osteoporosis, cancer)
138
Define a stress Fracture
A small crack in the bone caused by repetitive stress or overuse. This example shows a stress fracture in a metatarsal bone of the foot
139
S/S of a potential fracture (6)
Acute pain
Loss of function
Deformity
Shortening of the extremity
Crepitus
Local swelling and discoloration
140
Which diagnostic study would be used to confirm a fracture?
x-ray imaging (radiography)
141
What factors influence a fracture healing
Displacement and site of fracture
Blood supply
Other local tissue injury
Immobilization
Internal fixation devices
Infection
Poor nutrition
Age
Smoking
142
Name the Multistage healing process (union)
1. Fracture hematoma
2. Granulation tissue
3. Callus formation
4. Ossification
5. Consolidation
6. Remodeling
143
Define 1st stage of the fracture healing process - fracture hematoma
A blood clot forms at the fracture site, providing a framework for healing.
144
Define 2nd stage of the fracture healing process - Granulation tissue
Fibroblasts and new capillaries invade the hematoma, forming granulation tissue.
145
Define 3rd stage of the fracture healing process - Callus formation
Osteoblasts and chondroblasts form a fibrocartilaginous callus, bridging the fracture gap.
146
Define 4th stage of the fracture healing process - Ossification
The callus is gradually replaced by bony tissue (woven bone)
147
Define 5th stage of the fracture healing process - Consolidation
The woven bone is replaced by lamellar bone, restoring the bone's original structure.
148
Define 6th stage of the fracture healing process - Remodeling
The bone is remodeled to its original shape and strength.
Could take up to 2 years to fully heal
149
Which medication increases the risk of fracture and delay healing once fracture occurs
Corticosteroids
150
Define fat embolism syndrome
*Fat globules released from the bone marrow can travel to the lungs, causing respiratory distress.
*An early complication of a fracture
151
Why would shock be a complication of a fracture?
Can occur due to blood loss and pain, especially in severe fractures
152
When does a fat embolism present after a fracture occurs?
Presents 42-87hrs after
153
Define compartment syndrome - an early complication of a fracture
Increased pressure within a muscle compartment can compromise blood flow and nerve function.
154
Define VTE, PE - An early complication of a fracture
Venous thromboembolism (VTE) and pulmonary embolism (PE) are blood clots that can form in the veins and travel to the lungs, respectively.
155
Name delayed complications relating to fractures. (3)
Delayed union
Malunion
Nonunion
Avascular necrosis of bone
Complex regional pain syndrome (CRPS)
Heterotrophic ossification
156
Define delayed union
Fracture healing takes longer than expected
157
Define malunion
Fracture heals in an unsatisfactory position.
158
Define Nonunion
Fracture fails to heal
159
Define avascular necrosis of bone
Loss of blood supply to the bone can lead to bone death.
160
Define Complex Regional Pain Syndrome (CRPS)
A chronic pain condition that can develop after an injury, causing severe pain, swelling, and changes in skin color and temperature.
161
Define Heterotrophic Ossification
Formation of bone in soft tissues around the fracture site, limiting joint movement.
162
State emergency management of fractures
*ABCs - Airway, breathing, circulation
*Immobilize the body part
*Splint joints both proximal and distal to the suspected fracture.
*If open fracture, cover w/ sterile dressing.
*Assess neurovascular status before and after splinting
*Do not attempt to reduce (set the bone) the fracture
163
Open fracture, how should you cover this wound in an emergency?
Cover with sterile dressing to prevent contamination
164
defien cast
a rigid, external immobilizing device
165
Uses for a cast (4)
*Immobilize a reduced fracture
*Correct a deformity
*Apply uniform pressure to soft tissues
*Support and stabilize weakened joints
166
potential complications that could arise from casts
*Pressure ulcer: caused by inappropriately applied cast
*Disuse syndrome:muscle atrophy and loss of strength
167
How to treat disuse syndrome?
Isometric exercises
168
Educate patient with cast to report what s/s? (7)
*Persistent pain
*Persistant swelling
*Signs of infection or pressure area
*Changes in sensation, movement, skin color or tempt
169
Educate patient on what not to do with their cast (5)
DO NOT
*Get cast wet
*Remove padding
*Insert objects
*Bear weighton new cast for 48 hrs(not all cast are weight bearing)
*Cover cast with plastic for prolonged periods
170
171
Location of colles fracture
Distal radius
172
Which age group is most likely to get a colles' fracture and why?
*Adults greater than 50
*Due to osteopenia or osteoporosis
*Called 'fragility fracture' due to its association with weakened bones
173
Symptoms of colles' fracture (3)
*Pain
*Swelling
*Dorsal displacement of distal fragment - called silver-fork deformity
174
Complications with colles' fracture
*Vascular insufficiency (reduced blood flow)
*Carpal tunnel syndrome (CTS)
175
How to treat a colles' fracture
*Closed reduction with splint or cast
*Open reduction internal fixation
176
How to reduce edema relating to colles' fracture
*Rest
*Ice
*Elevate
*Analgesics
177
Nursing process: 6 P's
Pain
Pressure
Pallor
Pulselessness
Paresthesia
Paralysis
178
When completing pain assessment, what should be addressed?
exact site
characteristics
intensity of pain
179
You can't find pulse in extremity, what do you do?
Doppler -> call Dr -> NPO -> prep for surgery
180
Define compartment syndrome
*Medical emergency
*Requires prompt recognition and treatment
*Increased pressure in a confined space (ex: cast) and can cut off blood flow
181
What can cause compartment syndrome
Increased pressure in a confined space, typically a muscle compartment.
182
Result of compartment syndrome
compromised blood flow
183
Consequences of compartment syndrome
*Ischemia (lack of blood flow)
*Irreversible damage to the muscles and nerves which can occur within hours
184
How could nurse diagnose compartment syndrome
*Clinical assessment of the 6 Ps
*Pain is the early indicator*
185
TREATMENT of compartment syndrome
*Notify physician
*Cast may be removed
*Emergency fasciotomy may be necessary
186
Purpose of a traction device
*Reduce muscle spasms
*Reduce align, and immobilize fractures
*Reduce deformity
*Increase space between opposing forces
187
What should nurse monitor for when patient is in skin traction
*Inspect skin 3x day
*Palpate traction tapes to assess for tenderness
*Assess sensation and movement
*Assess pulses, color, capillary refill, and tempt of fingers or toes
*Assess for indicators of DVT
*Assess for indicators of infection
188
Ways to prevent DVT when patient is in skin traction
*Elastic hose (compression stocking)
*Pneumatic compression hose (compression stocking devie)
*Anticoagulant therapy (heparin, warfarin, lovanox)
189
Nursing priorities to manage with patient in traction
*Assess anxiety
*Assist w/ self-care
*Monitor and manage complications
190
What complications should the nurse monitor for and manage with patient in traction? (7)
*Pressure ulcer
*Atelectasis and pneumonia
*Constipation
*Anorexia
*Urinary stasis
*Infection
*DVT
191
Why are frequent post-Op neurovascular assessments so important?
neurovascular function (pulses, sensation, movement) are crucial to detect complications like compartment syndrome, nerve damage, hemorrhaging, increased risk of stroke.
192
Define arthroplasty
Reconstruction or replacement of a joint to relieve pain, improve or maintain range of motion (ROM) or correct deformity.
193
Goals of arthroplasty (3)
*Pain relief: To alleviate pain caused by joint damage or disease.
*Improved ROM: To restore or improve the joint's range of motion.
*Deformity correction: To correct any deformities in the joint.
194
Debridement Procedure
Uses a fiberoptic arthroscope to remove debris (pieces of bone or cartilage) or osteophytes (bone spurs) from a joint.
195
Most common site to debridement
Knee or shoulder joints are common sites for debridement.
196
Debridement post-op care
*Compression dressing: A compression dressing is applied to minimize swelling.
*Weight bearing: Weight bearing is usually permitted following knee arthroscopy.
197
Patient education reg debridement
*Restrict activity: Patients are advised to restrict activity for 24 to 48 hours post-procedure.
*Pain management: Patients are educated on pain management strategies.
*Signs of infection: Patients are instructed on recognizing and reporting signs of infection.
198
joint replacement purpose
Used to treat severe joint pain and disability and for repair and management of joint fractures or joint necrosis (bone death).
199
Associated complications with a pelvic fracture (6)
*Intraabdominal injury
*Compartment syndrome
*Paralytic ileus (intestinal obstruction)
*Sepsis (blood infection)
*Fat embolism syndrome (FES)
*Venous thromboembolism (VTE)
200
S/S of potential pelvic fracture complication developing (5)
*Abdominal swelling
*Abdominal tenderness
*Deformity in the pelvic region
*Unusual pelvic movement
*Bruising in the pelvic region
201
Main reason why pelvic fractures can be life threatening
Pelvic fractures can be very serious due to the proximity of major blood vessels and organs.
202
How to diagnose a pelvic fracture
X-ray and CT scan
203
A stable, nondisplaced pelvic fracture requires what treatment
These fractures often require minimal intervention, such as bed rest and pain management.
204
A complex, displaced pelvic fracture requires what treatment
These fractures require more aggressive treatment, such as:
*External fixation: A frame outside the body is attached to pins inserted into the bone to stabilize the fracture.
*ORIF (Open Reduction Internal Fixation): Surgical procedure to realign the bone fragments using plates, screws, or rods.
205
Hip fracture nursing priority
Hydration: Maintaining fluid balance is crucial.
Respiratory Support: Preventing respiratory complications is important.
Circulation Checks: Regularly monitoring circulation in the affected leg.
Pain Control: Effective pain management is essential.
Prevention of Immobility Complications: Preventing complications like DVT and pressure ulcers.
Hx of Chronic Conditions and Medications: Understanding the patient's medical history and current medications.
206
Post-Op care hip fractures nursing care
Cough / Deep Breath Q 2': Encourage coughing and deep breathing exercises every 2 hours to prevent pulmonary complications.
Stockings & Compression Devices to ↓ DVT, Venous Stasis: Use compression stockings and devices to reduce the risk of Deep Vein Thrombosis (DVT) and venous stasis.
Turn q2h, Maintain Leg Abduction: Turn the patient every 2 hours and maintain leg abduction to prevent complications and promote healing.
Circulation & Neuro Status √'s of Affected Leg: Regularly check circulation and neurological status of the affected leg.
Pain Control: Manage pain effectively with prescribed medications.
Mobilize ASAP: Encourage early mobilization as soon as possible.
√ Under Client for Drainage: Check under the patient for drainage.
Bottom Left Box: Complications
DVT: Deep Vein Thrombosis (blood clot in a deep vein).
Neurovascular Complications (Bleeding, Swelling): Bleeding and swelling can compromise blood flow and nerve function.
Pulmonary Complications (Atelectasis): Atelectasis (collapsed lung) can occur due to immobility.
Skin Breakdown (Pressure Ulcers): Prolonged immobility can lead to pressure ulcers.
Urinary Retention: Difficulty emptying the bladder.
Delayed Complications (Infection, Nonunion): Infection and nonunion (failure of the fracture to heal) can occur later.
Right Side Box: Watch For
Severe Pain: Indicates potential complications or inadequate pain control.
Inability to Move Leg: Suggests nerve damage or other complications.
Shortening & External Rotation of the Leg: Classic signs of hip dislocation.
207
Post-Op signs to watch for
Severe pain
Inability to move leg
Shortening & external rotation of the leg
208
Post-Op care Hip fracture complications
DVT: Deep Vein Thrombosis (blood clot in a deep vein).
Neurovascular Complications (Bleeding, Swelling): Bleeding and swelling can compromise blood flow and nerve function.
Pulmonary Complications (Atelectasis): Atelectasis (collapsed lung) can occur due to immobility.
Skin Breakdown (Pressure Ulcers): Prolonged immobility can lead to pressure ulcers.
Urinary Retention: Difficulty emptying the bladder.
Delayed Complications (Infection, Nonunion): Infection and nonunion (failure of the fracture to heal) can occur later.
Right Side Box: Watch For
Severe Pain: Indicates potential complications or inadequate pain control.
Inability to Move Leg: Suggests nerve damage or other complications.
Shortening & External Rotation of the Leg: Classic signs of hip dislocation.
209
Post-Op Immobilization
*A compression dressing may be used to immobilize the knee in extension.
*May be worn up to 4 weeks post-Op during ambulation
210
What is included in rehabilitation regarding a hip replacement
*Physical Therapy: Physical therapy is a crucial part of recovery.
*Pain management: Effective pain management is essential.
*Monitor for complications: Regular monitoring for complications is crucial.
211
Post-Op- What type of bandage is put on a patient w/ knee replacement surgery
*Compression bandage on knee: A compression bandage is applied to reduce swelling and provide support.
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Post-Op- How often should neurovascular status be assessed for a patient w/ knee replacement surgery
every 2-4 hours
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What complications should you monitor for regarding a patient w/ post-op knee replacement surgery
Monitor for complications; VTE, infection, bleeding: Close monitoring is essential to detect and manage potential complications.
*VTE (Venous Thromboembolism): Knee replacement increases the risk of blood clots.
*Infection: Infection at the surgical site is a concern.
*Bleeding: Post-operative bleeding needs to be monitored.
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Post-Op- Patient with knee replacement, what drain could they have and why? And when is it typically removed?
*Wound suction drain (Jackson-Pratt): A drain is used to remove excess fluid from the surgical site.
*Removed in 24 to 48 hours: The drain is typically removed within a few days.
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What is given prophylactically to a a patient with knee replacement and why?
Antibiotics to prevent infection
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Define continuous passive motion (CPM) needs of patient with knee replacement surgery
*Promote range of motion, circulation, and healing: CPM helps prevent stiffness and promotes healing.
*Prevent scar tissue in knee: It helps minimize scar tissue formation, which can limit movement.
*Placed in device immediately after surgery: CPM is typically started soon after surgery.
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What would P.T include for a patient with recent knee replacement surgery
Physical Therapy:
*Strength and ROM: Physical therapy focuses on regaining strength and range of motion.
*Assistive devices: Patients are taught to use assistive devices like crutches or walkers.
*Ambulate first post op day: Ambulation is typically started on the first day after surgery.
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How long would acute rehab include for patient with recent knee replacement surg
Acute rehab:
*1 to 2 weeks: Acute rehab usually lasts for 1 to 2 weeks.
*Total recovery 6 weeks: Total recovery can take up to 6 weeks.
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Define adbuction
Moving limb or part of a limb AWAY from the midline of the body
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Define Adduction
Moving a limb or part of a limb TOWARDS the midline of the body
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How could we promote physical mobility
*Maintain neutral position of hip: Proper hip alignment is crucial for preventing complications and promoting mobility.
*Use trochanter rolls: Trochanter rolls are used to prevent external rotation of the hip.
*Maintain abduction of hip: Abduction (moving the leg away from the midline) helps prevent hip dislocation.
*Isometric, quad-setting, and gluteal-setting exercises: These exercises help maintain muscle strength and tone.
*Use of trapeze: A trapeze bar can assist with movement and transfers in bed.
*Use of ambulatory aids: Ambulatory aids, such as crutches, walkers, or canes, can help with mobility.
*Consultation with physical therapy: Physical therapy plays a crucial role in developing and implementing a mobility plan.
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Musculoskeletal problems: Defe osteomyelitis
Osteomyelitis is an infection of the bone, bone marrow, and surrounding soft tissue.
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Musculoskeletal problems:
What could cause osteomyelitis?
*Infection in bloodstream: Microorganisms can enter the bloodstream from other areas of the body, and risk factors include age, debilitation, hemodialysis, IV drug use, and long-term IV catheters. The vertebrae are the most common site of infection in adults.
*Direct entry: Direct entry of bacteria into the bone, often in adults, can occur when an open wound (e.g., penetrating wound, fracture, surgery) allows microorganisms to enter the body. Other implants or devices in the body, such as a hip or knee replacement, can also introduce bacteria.
*Foot infection: May occur in the feet of people with diabetes or vascular disease-related ulcers or in the heel or sacrum from a pressure injury.
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Define Disarticulation
Amputation through a joint
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Main cause amputations occur?
peripheral vascular disease (PVD)
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Diabetes risk with amputation
Older clients with diabetes often have peripheral neuropathy that progresses to deep ulcers and gangrene, leading to amputation.
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Post Amputation care
*Stump Care: Proper care of the residual limb (stump) is essential for healing and prosthetic fitting.
*Phantom Limb Pain: This is a common phenomenon where patients experience pain in the amputated limb.
*Ambulation: Early ambulation is encouraged to promote healing and mobility.
*Assistive Devices: Assistive devices, such as crutches or walkers, may be needed for ambulation.
*Body Image: Amputation can significantly impact body image, and psychological support is important.
*Phantom Limb: This refers to the sensation that the amputated limb is still present, which can be a normal experience.
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Stump wound care immediately after surgery
*Elevate Stump: Elevate the stump for the first 24 hours to reduce swelling.
*Prevents Contracture: Helps prevent contractures (joint stiffness) by maintaining proper positioning.
*Of The Joints Above Amputation: Focus on the joints above the amputation site to prevent stiffness.
*Discuss Phantom Limb Pain: Educate the patient about phantom limb pain, a common experience.
*Analgesics: Administer pain medication as prescribed.
*Evaluate Healing: Monitor the wound for signs of healing.
*Compression Dressing: Apply a compression dressing to reduce swelling and shape the stump.
*Discourage Semi-Fowler's Position in Client With Above the Knee Amp: Avoid semi-Fowler's position in above-knee amputations to prevent hip flexion contractures.
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STUMP CARE AFTER WOUND HAS HEALED
*Assess For Skin Breakdown: Regularly assess the skin for signs of breakdown.
*Wash, Rinse & Dry Stump Daily: Maintain proper hygiene by washing, rinsing, and drying the stump daily.
*Do Not Apply Anything To Stump: Avoid applying substances like alcohol (dries skin) or lotion (makes skin too soft).
*Encourage Client To Wear Prosthesis When He Gets Up & All Day To Prevent Stump Swelling: Encourage prosthesis use to prevent swelling and promote shaping.
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NURSING IMPLICATIONS regarding amputations
Prevent Further Loss of Circulation To Extremity: Monitor circulation to the residual limb.
Promote Comfort: Ensure patient comfort through pain management and proper positioning.
Promote Optimum Level of Mobility: Encourage mobility and independence.
