Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSG 470 > Hip, and Amputations exam 2 > Flashcards

Hip, and Amputations exam 2 Flashcards

1
Q

Fracture

A

Break or crack in the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of fractures

A

-Trauma
-twisting, abuse
-Disease process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What age group heals fastest

A

Children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Average time to heal from a broken bone

A

3-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Open fracture

A

-Breaks through skin
-Also known as compound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Closed fracture

A

Doesnt break through skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complete fracture

A

-Separates bone into two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Incomplete fracture

A

Not broken all the way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Comminuted fracture

A

Bone is broken into a million fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a hip fracture

A

Break in the femur
-Classification depends on the location of the break

-Intracapsular
-Intrertrocaonteric
-Subtrochanteric

-Crack may be displased,or non dsiplaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Displaced hip fracture

A

Bone is broken and moved out of place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nondisplaced hip fracture

A

Bone broke and stayed in the original location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Intracapsular Hip fracture

A

Broken on the “neck” of the femur before the actual capsle
-Like right before the ball of the leg

-Repaired by screws into the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Intertrochanteric Hip fracture

A

Broken between the greater and lesser trochanter
-Repaired with screws and plates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Subtrochanteric Hip fracture

A

Break on the actual femur itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

S+S hip fracture

A

-Shortening of extremity
-Potential for Neurovascular compromise
-Pain
-Deformity
-Swelling and discoloration
-Crepitus
-Loss of function
-Redness
-Bruising
-Limited movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Main 3 things with S+S Hip fracture

A

-Leg is shortened
-Leg is abducted
-Leg is externally rotated

(confirm with Xray/MRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Initial treatment of hip fracture

A

-Stabilize the pt first, see them first
-Immobilize body part
-Assess (Vitals, cognition, neurovascular status)
-DONT TRY TO MOVE LEG
-Get a good history, call provider
-Know lab values/vitals in case the need srgery
-Prep for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Open reduction internal fixation (ORIF) Hip fracture treatment

A

Surgeon, puts bones back in place with screws and stuff, its stabilization

Surgery Recommended within 24-36 hours of the fracture
Antibiotics are given before and after
DVT precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Total hip arthroplasty hip fracture treatment

A

-Upper femur and socket are completely replaced

Surgery Recommended within 24-36 hours of the fracture
Antibiotics are given before and after
DVT precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Partial hip arthoplasty, hip fracture treatment

A

End of femur is replaced with metal

Surgery Recommended within 24-36 hours of the fracture
Antibiotics are given before and after
DVT precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complications of Hip fracture

A

-Infection
-Osteomyelitis
-Compartment syndrome, Neurovascular compromise
-Fat embolism and DVT
-aVascular necrosis
-Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Osteomyelitis

A

Bone infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Compartment syndrome

A

Increased pressure on individual compartments within fascia, fascia doesn’t expand
-Frequent neurovascular assessments
-6 p’s
-If not reversed within 6 hours you are getting amputated
-Leads to blood and nerve damage and potentially limb compromise
-Pressure builds up and pressures on the nerve and blood vessels
-DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Avascular necrosis

A

Failure of an area to heal, due to poor perfusion leading to death of tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

5 P’s

A

Pain, pallor, Paresthesias, Paralysis, pulselessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Early sign of compartment syndrome

A

Pain, unrelieved by anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Late sign of compartment syndrome

A

Pulselessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Compartment syndrome mgmt

A

-Call provider, loosen clothing, remove jewelry
-Keep limb heart level
-surgical mgmt with a fasciotomy, Leave open to air or wound vac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pre-op mgmt of hip repair

A

Instruct on use of incentive spirometer, before procedure
Make sure informed consent is signed, if not call the provider to come back and talk
Review labs
-CBC
-Electrolytes
-BUN and creatinine
-Chest x-ray
-ECG
Teach about postoperative care
-Transfusion
-Drains,
-Pain control
-Transfer, PT
-Hip precuations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Post op mgmt of pt with hip repair

A

-Pain control, may have a PCA
-Prevent joint dislocation
-Assess neurovascular status
-Notify provider of any changes such as swelling, increased join pain, pain, bleeding, infections
-Caring for incisions with daily soap and water cleaning
-PT, will be discharged with PT always
-Monitor for DVT and PE
-Use anti-embolism stockings
-Anticoagulation
-Monitor for bleeding
-Prevent pressure ulcers
-Offload heel with a blanket
-Emotional support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Who takes care of the first dressing change

A

Surgery, then we can take care of it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Preventing hip dislocation

A

-Maintain neutral position of the hip
-Trochanter rolls
-Maintain abduction of hips NO CROSSING LEGS
-Ambulatory aids
-Elevated toilet seat
-Straight back arm chairs, avoid flexion
-Avoid turning to the affected side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What degree of flexion should be avoided to prevent hip dislocation

A

90 Degrees

DONT CROSS LEGS
DONT BEND FORWARD AT THE WAIST OR MOVE LEGS PAST 90 DEGREES
DONT TURN FOOT IN AND OUT EXCESSIVELY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Early ambulation with hip surgery

A

-Moving within 24 hours after surgery
-Using proper assistive devices

36
Q

Wound care hips surgery

A

Dressings
-Drains, record drainage
-Lab values, monitor for anemia, may need transfusion

Infection control

37
Q

Amputation Definition

A

-Partial or complete removal of a limb
-Considered a surgical reconstruction procedure
-Used to relieve symptoms, improve quality of life

38
Q

Number one cause of non-traumatic amputations

A

Diabetes

39
Q

How may an an amputation be used to relieve symptoms/preserve life

A

-Wound may not be healing, osteomyelitis, sepsis, death

40
Q

What is number one concern with someone with an amputation

A

Physical stability, including neurovascular status, pain, surgery

-Other needs are second

41
Q

RN as facilitator,Amputation

A

-Help pt identify/mobilize/develop personal strengths
-Physical and psych needs

42
Q

RN as a nurturer, Amputation

A

Gentle encouragement/support personal strengths
-Celebrate small accomplishments
-Accept the amputation, being able to look at it

43
Q

RN in unconditional acceptance, Amputation

A

Empathy, accept as worthy
No strings attached

44
Q

Medical Amputation

A

-74% of cases, DIABETES is number one cause
-PVD, pt is not able to get enough blood flow to the extremity
-Cancer
Gangrene
-Infection (Usually lower extremity)

45
Q

PVD assessment and mgmt

A

5 P’s
-Skin feels cool
-Molting of skin
-Try and reperfusion extremity first, if that doesnt work you amputate

46
Q

Trauma amputation

A

-23% of amputations
-Crashing injuries
-Burns
-More risk of infection as wound bed is not clean

47
Q

Mgmt of Trauma amputation

A

-Bring the chunk of flesh you took off to the hospital, first wrap it in gauze, put it in a ziplock bag and put the bag on ice. Flesh should not come into contact with the ice directly
-Elevate the affected extremity as its bleeding

48
Q

Congenital amputation

A

Kid is born without an extremity
-3% of amputations
-Can affect upper and lower

49
Q

How is level of amputation determined

A

-Preformed at most distal site that will heal
-Needs circulation for healing (Evaluated with doppler flowmetry and angiography)
-Cause of amputation
-What level will provide the most function
-What comorbidities they have that can affect healing

50
Q

What type of amputation is preferred and why

A

Below knee amputation as the knee is hella important for movement

51
Q

Open Guillotine amputation , Indication

A

Used for infection/ poor surgical risk patient
-Used to chop of the extremity to cut away the diseased part, and once the infection subsides they go in for another surgery

52
Q

Open guillotine amputation

A

-Clean cut straight through, like they just sawed it off
-Allows for drainage to promote healing
-Healing by granulation and secondary closure
-Stump closure required after infection subsides

53
Q

Closed flap amputation

A

-Skin flap covers the residual limb
Used mostly for vascular disease
-Done after guillotine amputation only after infection subsides

54
Q

Nursing interventions post op amputation

A

-Prevention of complications (DVT, PE, Urinary stasis, Pressure ulcers)
-Prevention of hemorrhage (Slow vs massive)
-Pain mgmt
-Prevent infection
-Promote wound healing
-Absence of altered sensory perception (Phantom limb pain)
-Acceptance of altered body image
-Promotion of self care
-Restoration of physical mobility

55
Q

Pre-op priorites, teaching Amputation

A

-Teaching coughing, deep breathing (Prevent resp complications)
-Positioning and OOB asap
-Pain control
-Dressing type (Residual limb, rigid cast)
-Placing prone to prevent contractures

56
Q

Immediate post op nursing interventions, amputation: Hemorrhage

A

-Massive vessel can be severed, monitor vitals and drainage to see
-Keep tourniquet at bedside

-Also look out for S+S of poor circulation, if there isnt a pulse, notify provider know as that can indicate poor blood flow and can lead to limb death

57
Q

Immediate post op nursing interventions, amputation: Infection

A

-Wound care and dressing changes
-Preventing edema (Wrapping the residual limb)
-Traumatic amputations have a high risk of infection as the wound is contaminated with what made the amputation
-S+S of infection, red warmth, fever, leukocytes

-If infection, administer antibiotics as prescribed
-Observe wound and drainage

58
Q

Immediate post op nursing interventions, amputation: Skin breakdown

A

-Maintain skin integrity
-Can be from immobilization or poorly fitting device
-Healed limbs should be washed and dried 2x a day, nothing aggressive
-No lotions or oils
-Look for blisters
-Limb sock changed daily, make sure there isnt any wrinkles
-Dont wear prosthetic when leg is irritated

59
Q

A pt with a leg amputation has a blister on the affected leg, should the pt wear the prosthetic, why or why not

A

No dont wear your prosthetic when there is a blister as it will only further break down the skin

60
Q

Immediate post op nursing interventions, amputation: Phantom limb pain

A

-Pain mgmt
-Keeping pt active
-Kneading massage to desensitize
-Distraction techniques
-Trans-cutaneous electrical nerve stimulation. (TENS)
-Local anesthetic

61
Q

Immediate post op nursing interventions, amputation: Joint contracture

A

-Prevent deformity
-Mgmt is done by placing pt prone periodically

62
Q

Immediate post op nursing interventions, amputation: Neurovascular checks

A

Circulation
-Sensation
-Movement
-Pulses

5p’s

63
Q

Discharge and planning goals amputations

A

-Rehab center
-Use prosthetic
-Alleviating pain, preventing complication
-Safe use of wheelchair and how to maximize function
-Theyre grieving the loss of the limb, help with body images

64
Q

Phantom limb sensation

A

-Feels as if limb is still there
-More common in traumatic amputations
-Feels so real that a pt might try and step with it
-May have pain sensation
-Warm cold, itching , burning or actual pain
-May last for up to 2 years, diminishing over time

65
Q

Cause of phantom limb

A

Caused by intact peripheral nerves proximal to amputated site that carries messages from the brain to the amputated site

66
Q

Types of prosthesis: Closed or removable rigid cast

A

-Applied right after surgery
-Controls edema
-Supports circulation, promotes healing
-Shapes residual limb
-Permits attachment of prosthetic extension and early ambulation
-Fiberglass or plaster

67
Q

Types of prosthesis: Soft dressing (Stump dressing)

A

-Secured with elastic bandage, allowing for frequent inspection of wound
-Used for when there is significant wound drainage
-Used in pt who need to AVOID early weight bearing
-May require wound drain systems to prevent hematomas and prevent infection
-Distal to proximal, anchoring to highest joint
-Used for uniform compression, lower pain, shape limb, prevent contracture

68
Q

What amputation patients should avoid early weight bearing

A

PVD patients

69
Q

Amputation Cast care, rigid

A

-BKA might be cast in surgery

-Used to prevent edema, contractures, decrease pain and provide protection
-Cast is in place for 3-4 weeks
-A window might be placed for inspection of wound

70
Q

Amputation, Soft dressing cast care

A

Frequent dressing changes
Inspection of suture

-Proper positioning to prevent edema and contractures
-1st 24 hours only elevate leg on pillow to prevent edema
-After 24 hours position pt on abdomen or flat supine position to prevent contracture and allow future use of prosthesis

-Place them prone to prevent hip contractures
-Dont place pillows between legs
-Dont have pt sitting upright in chair/bed for long prolonged period

71
Q

Why do we place pt prone in amputations

A

Prevent hip contractures, straightens out angle of the hip

72
Q

Stump care and wrapping, pt teaching

A

Figure 8 patterns to SHAPE it into a cone to fit prosthesis, minimize edema

-Wrap and rewrap, every 4-6 hours for the first 24 hours and then at least once a day
-Preform the wrap with extremity elevated to prevent edema
-ROM exercises
-Wound inspection

73
Q

Figure 8 technique

A

Distal to proximal, stump to body
-Reapply 3-5 times a day when first starting out

74
Q

Amputation Rehab

A

-Proper positioning of limb, No abduction, external rotation, and flexion
-Turn pt frequently, prone is best
-Assistive devises
-ROM exercises
-Muscle strengthening exercises
-Provide pre-prosthetic care, proper bandaging, massage and toughing of residual limb

-Transfer teqniques for bed, toilet, chair ect.
-Ambulation with crutches, walker, wheel chair

-May need psych support

75
Q

Emergent care for a fracture

A

-Stabilize pt, immobilize fracture proximal and distal before moving pt
-Splint extremity
-Check color, sensation, and movement, temp (5 p’s)
-Cover an open fracture with a sterile dressing

76
Q

Purpose of traction

A

Pulling the limb to realign the bone
-Done in a closed reduction
-Weights must hang free

77
Q

mgmt of a fracture

A

-Reduction
-Elevate and Ice
-Neuro checks 6 p’s
-Position changes, maintain skin integrity
-Skin care
-Infection
-Pain mgmt
-get them moving asap
-Coping
-Edema mgmt

78
Q

Complications of open fractures

A

Osteomyelitis, Tetanus, gas gangrene

79
Q

Early complications of fractures

A

-Shock (Loss of fluid)
-Fat embolism
-Compartment syndrome
-VTE, DVT
-Infection (osteomyelitis, wound)
-DIC: (Wide spread hemorrhage, little blood clot)

80
Q

Late complications of fractures

A

-Union of bone isnt ideal (Delayed, malunion, Nonunion)
- Avascular necrosis,
-Complex regional pain syndrome
-Heteropropic ossification

81
Q

Heteropropic ossification

A

Bone grows where bone shouldnt grow, calcification

82
Q

Shock mgmt

A

ABC
-Intravascular volume replacement
-Stabilize fracture
-Decrease Pain
-Monitor for further bleeding
-More trauma than expected

83
Q

Fat embolism signs

A

-Hypoxia, tachypnea, tachycardia, dysnepea, substernal chest pain, low grade fever, crackles
-Chest X ray (ARDS, or normal)
-Petechial rash
-Neuro changes

-Its a diagnosis of exclusion

84
Q

Fat embolism triad

A

-Hypoxemia
-Neuro compromise
-Petechial rash

85
Q

Fat embolism mgmt

A

-Supportive
-o2, fluids, vassopressors, vent, steroids

86
Q

Fat embolism

A

Occurs after something like a bone break where globules of fat travel to where they arent supposed to go like brain kidney and lungs

87
Q

Complex regional pain syndrome

A

-Rare occurs from fracture usually
-Pain in limb is disproportionate to fracture
-Can be reflex systemic dystrophy or causalgia
-Causes, burning pain, local edema, hyperesthesis
-Skin can be warm, red, dry, cool, sweaty, cyanotic, or trophic changes, glossy shinny skin, changes in nails and hair

-Main nursing consideration is no BP or venipuncture

NSG 470 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions