Fractures

Question 1

Nursing care for pt’s w/ a fracture?

Answer 1

ABC’s, Head-to-toe, Hx, Mechanism of injury,
Direct pressure of bleeding sites,
Immobilization of extremity,
Cover any open areas w/ a dressing (sterile)

Question 2

What’s a skin traction?

Answer 2

Force applied to soft tissues w/ a weight/pulley system to maintain alignment using splints, bandages or boots (wt. 5-7lb)

Question 3

What’s a skeletal traction?

Answer 3

Pins, wires, screws are surgically implanted to the bone and weights are attached to hardware pulling in diff directions to maintain alignment (wt. 25lb)

Question 4

Why is skin traction used?

Answer 4

To keep alignment and decrease muscle spasms

Question 5

Why is skeletal traction used?

Answer 5

If pt has soft tissue damage or when greater force is needed

Question 6

What are 2 important things to assess for skin tractions?

Answer 6

Skin integrity and perfusion

Question 7

What is important to assess for skeletal tractions?

Answer 7

Skin integrity and infection

Question 8

What are 2 important things to assess for if a pt has a cast?

Answer 8

Hot spots (infection) neurovascular check

Question 9

What is open reduction and internal fixation (ORIF)?

Answer 9

Surgery used to internally repair a bone fracture into correct alignment, use pins, screws, plates, nails, wires or rods to keep bone in place

Question 10

What is external fixation?

Answer 10

Screws and pins are placed into bone above/below fracture then attached to metal bar outside of skin

Question 11

What is electrical bone stimulation?

Answer 11

An electrical current is sent to fracture site, used if site won’t heal properly

Question 12

Why would electrical bone stimulation be contraindicated?

Answer 12

Upper extremity fracture or pt has a pacemake

Question 13

What is a intracapsular fracture?

Answer 13

Fracture across head or neck of the femur

Question 14

What is a extracapsular hip fracture?

Answer 14

Fracture w/in the trochanter region

Question 15

How will a fracture site appear?

Answer 15

Bruised, externally rotated and shortened

Question 16

How will a dislocated extremity look?

Answer 16

Internally rotated and shortened

Question 17

What are the pts biggest complaints in a fracture?

Answer 17

Pain, uncomfortable to sit (most comfortable when flat) muscle spasms

Question 18

What are the 5 P’s for a neurovascular check?

Answer 18

Pain
Pallor
Paresthesia
Pulses
Paralysis

Question 19

How often do you do a neurovascular check?

Answer 19

Every Time you check VS, in post op more often then q4h when stable

Question 20

Pre op management for hip fractures?

Answer 20

NPO, IVF (NS, D5 1/2) to prevent dehydration
Pain control intermittent in ED, PCA on unit (bolus of dilaudid)
Xrays, Stabilize extremity (Buck’s traction),
Lab studies (CBC, H/H, BUN/CRT, PT/PTT/INR)

Question 21

What is general anesthesia?

Answer 21

When pt is knocked out and intubated

Question 22

What is an epidural used for?

Answer 22

If pt is a high risk pt and unable to handle general anesthesia, is shorter/not intubated

Question 23

What do you expect in PACU?

Answer 23

Stable VS, consciousness, pain controlled, no N/V

Question 24

What are some open reduction internal fixation procedures for a hip fracture?

Answer 24

Intramedullary rods (IM rods)
Intramedullary nails (IM nails)
Plates and screws

Question 25

What is an arthroplasty?

Answer 25

Prosthesis

Question 26

What is a hemiarthroplasty?

Answer 26

Replacement of head of femur

Question 27

Post op care?

Answer 27

Positioning (alignment) w/ legs abducted (V shape) Wt bearing status (partial) Ambulation and PT

Question 28

Complications to monitor for?

Answer 28

Pressure ulcers, atelectasis, dislocation, VTE, PE, compartment syndrome, fat embolism syndrome, infection, bleeding, malunion

Question 29

What is a Pulmonary embolism?

Answer 29

Obstruction of the pulmonary artery by a blood clot; can occur @ anytime

Question 30

Name this complication: altered mental status (earliest sign), tachycardia, slight fever, tachypnea, chest pain, dyspnea, crackles, decreased O2 sat, mild thrombocytopenia?

Answer 30

Pulmonary embolism

Question 31

Whats a clue in a pts history for a pulmonary embolism?

Answer 31

Recent surgery

Question 32

How do you treat a pulmonary embolism?

Answer 32

Bed rest, O2, anticoagulants, possible thrombolytic therapy, mechanical ventilation, PLT monitoring

Question 33

What's a normal aptt in a pt who isn't receiving an anticoagulant?

Answer 33

25-39

Question 34

What is the goal of anticoagulation?

Answer 34

1.5-2 times of normal

Question 35

How often is aptt measures? and what should be done based on those results?

Answer 35

Daily; heparin drip adjusted per orders

Question 36

What do you measure in a pt taking Coumadin?

Answer 36

INR

Question 37

Explain compartment syndrome.

Answer 37

Swelling to the extremity prevents circulation of an extremity, histamine is released causing increase in blood flow thats trapped causing nerve tissue death which releases myoglobin that clogs the renal tubules causing renal failure

Question 38

How long does it take for the loss of a limb to occur in compartment syndrome?

Answer 38

6hrs

Question 39

What is the treatment for compartment syndrome?

Answer 39

Faciotomy- long incision to release pressure

Question 40

What is the key sign to compartment syndrome? And a late sign?

Answer 40

Pain out of proportion to extremity; paralysis of limb or pulselessness

Question 41

How will a pt w/ compartment syndrome present?

Answer 41

Swelling, pressure, cool extremity, decrease to absent pulses, change in sensation/motion

Question 42

Explain fat embolism syndrome?

Answer 42

Fat globules are released from bone marrow, enter the bloodstream, travel to the pulmonary vascular bed and obstruct

Question 43

Why doesn't fat embolism syndrome respond to anticoagulants?

Answer 43

Bc its fat.....duhh!

Question 44

How long will it take fat embolism syndrome to occur?

Answer 44

12-48hrs

Question 45

What is the earliest sign of fat embolism syndrome?

Answer 45

Altered mental status due to hypoxia/hypoxemia

Question 46

What are some key features to fat embolism syndrome?

Answer 46

Hypovolemia, pulmonary edema, capillary permeability, and a "snowstorm" effect on the xray

Question 47

How will a pt w/ fat embolism syndrome present?

Answer 47

Petechiae rash to upper extremity, cough/bloody frothy sputum, same s/s as PE

Question 48

True or false. Fat embolism syndrome is curative?

Answer 48

False

Question 49

What the key nursing actions of fat embolism syndrome?

Answer 49

``` Gentle handling of extremity, early immobilization, 100%O2 w/ non-rebreather mask Possible mechanical ventilation, Hydration, fluid resuscitation, Possible transfusion/steroids ```

Question 50

A low grade temp is expected post op, what temp should ring "infection" and after what time period?

Answer 50

38.5+; 48hrs+ (also have increase HR/decrease BP)

Question 51

Infection in an elderly pt will appear as what?

Answer 51

A change in mental status

Question 52

When should you check the dressing postop?

Answer 52

Immediately on arrival to unit from PACU then q4h

Question 53

Management of bleeding and anemia?

Answer 53

Assessment of hip dressing, measure drainage from surgical drain, BP lower than baseline, autologous transfusion, monitor H/H

Question 54

What is the average amount of drainage from a surgical drain postop?

Answer 54

50mls/8hrs

Question 55

What is delayed healing?

Answer 55

Prolonged healing

Question 56

What is malunion?

Answer 56

Incorrect healing

Question 57

What is nonunion?

Answer 57

Failure to heal

Question 58

How are the unions diagnosed and how are they treated?

Answer 58

Xray; surgical intervention and/or electrical stimulation

Question 59

What are factors that influence functional status after surgery?

Answer 59

Age, balance, cognitive ability, gender, fatigue, pain and complications

Question 60

What are the best indicators of recovery?

Answer 60

Balance and cognitive ability

Question 61

What are major risk factors for total hip arthroplasty?

Answer 61

Osteoarthritis (degenerative joint disease)

Question 62

Decisions to have total hip arthroplasty?

Answer 62

Pain (drugs don't work) interrupts sleep, Unable to maintain desired quality of life/ADLs Pt capable of participating in posop rehab

Question 63

If a pt has cemented total hip arthroplasty what are the advantages/disadvantages?

Answer 63

Can resume activity faster; can loosen and may need revision surgery

Question 64

If a pt has noncemented total hip arthroplasty what are the advantages/disadvantages?

Answer 64

Lasts longer (10-15yrs); limits activity for 6wks

Question 65

What is significant about dental work when considering a total hip arthroplasty?

Answer 65

Can cause infection that can lead to heart damage or complications to prosthetic so get done before

Question 66

What should a pt receive preop for several wks if a pt is anemic?

Answer 66

Epoetin Alpha to stimulate RBC production to decrease need for transfusion

Question 67

What hgb level alerts the surgeon for a blood transfusion?

Answer 67

8

Question 68

What is given preoperatively to have ready that may be needed during surgery?

Answer 68

Autologous blood donation

Question 69

What is the assessments to check for risk factors of a VTE in preop?

Answer 69

Hx, immobile, underlying clotting disorders, increased age, smoking

Question 70

What are the 3 rules to teach about exercises and transfers in postop?

Answer 70

No stooping/flexing No bending at a 90 degree angle No crossing legs (could cause dislocation)

Question 71

When should you stop anticoagulants before surgery?

Answer 71

1wk

Question 72

What kind of soap should a pt shower w/ morning of surgery and what should they not do?

Answer 72

Antibacterial soap/do not shave legs bc could cut self and cause an infection during surgery

Question 73

Whats another name for an epidural?

Answer 73

Neuroaxial

Question 74

What are some disadvantages/advantages to a longitudinal incision at the anterolateral thigh?

Answer 74

8-10cm on hip, has more muscle loss, decreases risk of dislocation but has longer recovery

Question 75

What are some advantages/disadvantages to posterolateral into thigh/buttock?

Answer 75

20-24cm, less muscle involved, higher risk of dislocation

Question 76

What types of drains are usually used in post op?

Answer 76

Jackson-Pratt/Hemovac

Question 77

How should a pt be positioned postoperatively?

Answer 77

Supine, head slightly elevated, may have over bed trapeze

Question 78

A pt should not sit how postoperatively?

Answer 78

No crossing legs or sitting @ 90 degree angle

Question 79

What could be assessed in post op?

Answer 79

Pain, skin breakdown, 5 P's, assess for any complications, compare operative leg w/ inoperative leg

Question 80

What are some low molecular weight heparins used in postop that are all XA inhibitors (clotting factors), cause fewer bleeding complications, and don't affect PT or aPTT significantly?

Answer 80

Enoxaparin (Lovenox) Dalteparin (Fragmin) Tinzoparin (Innohep)

Question 81

What can low molecular weight heparins cause? So what should you monitor?

Answer 81

Thrombocytopenia; platelets

Question 82

What should you assess for in a pt taking heparin?

Answer 82

Bleeding to IV site, gums, stools and neuro status

Question 83

What med should be given 72hrs before discharge? What Heparin antidote is used as well?

Answer 83

Coumadin | Protamine Sulfate

Question 84

To monitor postop pain what how long may NSAIDs be used for?

Answer 84

Up to 14days

Question 85

To help w/ progression of activity in postop when should a pt get out of bed?

Answer 85

Day 1

Question 86

What should be started right away after surgery?

Answer 86

PT eval and PT

Question 87

How should you assist a pt OOB in postop that prevents hip hyper flexion?

Answer 87

Stand on pt's affected leg side, pt sits on side of bed (not @ 90degree/no bending @ waist) stand up, pivot on unaffected leg to chair

Question 88

If pt has cemented implants what should their weight bearing status be?

Answer 88

Usually PWB right away

Question 89

If a pt has non-cemented implants what should their wt bearing status be?

Answer 89

PWB 1st few wks until bony ingrowth occurs per xray

Question 90

What special devices should be ordered for a pt post op to help w/ progression of activity and prevent hip hyper flexion?

Answer 90

Elevated toilet seats, firm seat high back wheelchair

Question 91

How long of a stay will a pt usually stay in postop?

Answer 91

3days

Question 92

How long does acute rehab usually take? And completion of rehab

Answer 92

Approx. 1-2wks; about 6wks

Question 93

Safety @ home for pt after surgery?

Answer 93

No clutter/throw rugs! Secure electric/extension cords, Adequate lighting, accessibility, Shower chair, elevated toilet seats

Question 94

What is it called when a spinal disc ruptures allowing the fluid in the disc to leak out and irritate nearby nerves?

Answer 94

Herniated disc

Question 95

Excess wt, regular heavy lifting, bending and twisting, previous back probs, tall height and bone disorders are risk factors for what?

Answer 95

Herniated discs

Question 96

Name this type of herniated disc: not compressing a nerve is asymptomatic, if compressing nerve then pain in lower back, buttocks, thigh and leg, numbness/tingling and muscle weakness and may cause sciatica?

Answer 96

Lumbar discs

Question 97

Name this type of herniated disc: numbness/tingling, muscle spasms, weakness in areas serviced by affected leg, stiff neck, neck and shoulder pain shooting into arm or fingers?

Answer 97

Cervical discs

Question 98

Treatment for herniated discs?

Answer 98

Pain meds or surgery

Question 99

What are the 4 classic symptoms of Parkinson's?

Answer 99

Tremor, rigidity, bradykinesia and postural instability

Question 100

Where do tremors usually occur in Parkinson's?

Answer 100

Hand, foot, jaw, legs or pill rolling

Question 101

What occurs in rigidity in a pt w/ Parkinson's?

Answer 101

Resistance to move bc of contraction of all skeletal muscles

Question 102

What occurs in bradykinesia in a pt w/ Parkinson's?

Answer 102

Slow movements, shorter steps (shuffling gait), no arm swing, decrease blink rate, difficulty swallowing, chewing or w/ speech

Question 103

What are some nonmotor skills that appear in Parkinson's?

Answer 103

Fatigue, loss of sense of smell, confusion, memory loss, dementia, slowed thinking

Question 104

Osteoporosis, osteogenesis imperfecta, Bone CA, inadequate intake of vit D, Ca and phosphate, aging, and trauma are all what?

Answer 104

Risk factors for fractures