Module 3 Surgical/ortho Flashcards
What do bones do?
•They Provide supporting framework
●Allows us to bare weight
●Protect vital organs
●Serve as a point of attachment for muscle and ligaments
●Bone marrow (inside bone) contains hematopoietic tissue that makes red/white blood cells
What are the 3 types of Muscle? And what do they require?
3 types:
●Cardiac
●Smooth
●Skeletal
●Require nerve impulses
●energy sources (ATP),
● electrolytes (calcium, phosphorous)
What are gerontological considerations related to bones?
●Loss of bone density
●Muscle mass/strength decrease by about 30% at 70 years old
●Loss of motor neurons
●Tendons/ligaments become more rigid
●Higher risk for Osteoarthritis and Osteoporosis
How would you care for the older adult?
●Know that these conditions limit their self-care and other activities
●they have Increased discomfort or chronic pain, immobility
●Risk for falls d/t loss of strength/ unawareness of limitations
●Assist with cane/wheelchair, room safety
●Review hx/meds that may effect musculoskeletal system
Health Hx Eval for the older Adult
• Health perception – health management pattern
• nutritional - metabolic pattern
• elimination pattern
• activity – exercise pattern
• sleep – rest pattern
• cognitive - perceptual pattern
• self – perception – self – concept pattern
• Role - relationship pattern
• sexuality – reproductive pattern
• coping – stress tolerance pattern
• value - belief pattern
What are the 4 basic diagnostic studies?
●X-ray
●Bone Scan
●CT Scan (computed tomography)
●MRI
What are the manifestations of fractures? (S/S) and what is the classic sign?
●Bruising
●Crepitation
●Edema
●Loss of function
●Muscle spasm
●Pain
● classic sign = deformity
What are the 6 ways we treat fractures?
•Reduction
•traction
•surgery
•cast
•splint
•brace
What is closed reduction?
●Local or general anesthesia is used
●Traction / countertraction used
●Casting, traction, braces, or splints may be applied after
What is open reduction?
●Usually includes interval fixation
●Risk associated
●ORIF (open reduction internal fixation) promotes early ambulation
What is traction and what are the most common types?
●Traction- application of pulling force to an injured body part
●types: skin and skeletal
What are the benefits of using traction?
●Prevents / reduces spasms
●Immobilizes the extremity
●Reduce a fracture / dislocation
●Promotes active and passive exercise
●Expands a joint space during surgery
What are the complications of using traction?
•Infection #1
•skin breakdown/pressure ulcers
•Non-union (pulled too much to heal from weight)
How long are tractions placed and what is the weight range?
•48-72 hours
•5-45 lbs
What are the 6 P’s of the Neurovasuclar Assessment?
•pain
•pulse
•pallor
•paresthesia (tingling)
•paralysis
•pressure
What is the Nursing Management for Fractures?
●Immobilize the extremity right away if fracture is suspected
●Neurovascular assessment (6 P’s) distal to the fracture
●Post-op:
●Nutritional therapy
●Work w/PT to get pt up when time
●Psychosocial issues
Pelvic Fracture overview
●Can be life threatening depending on mechanism of injury/ associated vascular damage.
●HIGH mortality rate d/t hemorrhage & complications.
●Abdominal assessment: local swelling, tenderness, deformity, bruising abnormal movement.
●Dx: X-ray and CT scan
What is involved in a Stable Pelvis Fracture?
●Involves a single bone
●May heal with conservative treatment: rest, pain meds, PT, walker
●Can take 8-12 weeks to heal
What is involved in an unstable pelvic fracture?
●“Open book” = separation of symphysis pubis, vertical or lateral position.
●Tx: stabilize pelvis, compressing bleeding vessels (treat the shock), after stabilization ORIF or external fixation.
Huge medical emergency
20% of unstable pelvic fractures require >15 units of blood in 24 hours!
Tx/Nursing management of Pelvic Fractures?
Depends on if stable vs. unstable.
●Stabilize first!
● Complex/displaced fractures will require external fixation or ORIF.
● Only turn the patient when ordered to do so by MD.
●Assess bowel and urinary elimination frequently.
●Distal neurovascular assessment (6 P’s!)
●Back/skin care when patient is raised from bed.
What are complications of Pelvic Fractures?
Internal injury to organs…especially bladder!
●Long term complications:
●Malunion (forms incorrectly)
●Nonunion (doesn’t heal at all)
●Residual gait disturbances
●Chronic back pain (walking problems/causes pain)
When is it considered a hip fracture?
When the proximal (upper) 1/3 of the femur is injured.
What is the most commonly noticed sign of a hip fracture?
Shortening and external rotation of the affected extremity
What is the Tx for a hip fracture?
●Immediate surgery is the standard of care.
●May initially be stabilized with Buck’s traction.
What are the surgical options for Hip fractures?
●Closed reduction with percutaneous pinning (CRPP)
●Internal fixation devices
●Replacement of femoral head with prosthesis (partial hip replacement)
●Total hip replacement
What is the post-op/Nursing Management for Hip Fractures?
●Decrease edema
●Use pillow between legs when turning
●Encourage use of trapeze bar for repositioning
●Do not turn on affected side!
●Teach positions that can cause dislocation (pg 1464)
*assess site for REEDA, 6 P’s, Vitals, I&O’s, IS, Pt up/walking 6hrs (1st w/walker, then cane- within weeks)
What are complications of Hip Fractures?
●Dislocation-teach Pt signs (external rotation, shortening, severe pain, lump on butt area)
●Nonunion
●Avascular necrosis
●Osteoarthritis
●Affected leg may be shorter- cane or shoe lift may be needed for safety
What are are some Surgical Joint Procedures?
●ORIF
●Closed reduction with fixation
●Meniscectomy-(excision of part of the meniscus -cushion around knee. Done by arthroscopy.)
●Arthroplasty- total or joint
●Amputation
What is the difference between Arthroplasty vs. Arthroscopy?
Arthroplasty is fully cut open vs. arthroscopy is smaller incisions and done with scopes (small cameras/tools)
What is the post-op care for a knee Arthroplasty?
●Compression dressing
●Knee immobilizer
●PT right away & outpatient after d/c.
●Anticoagulants Parental abx (10-14 days)
●PT (rest for 4 wks, weight is restricted, no working. Straight leg raise, gentle ROM, 90 degree flexion before going home/full weight bearing)
What is the post-op care for Total Hip Arthroplasty?
●Replacement of hip joint to relieve pain and restore function for patients
●Prosthesis (implant) Management of care is same as hip fracture management :
●6 P’s
●Nutrition
●PT
●See page 1463-1466, table 62.11 “Patient & Caregiver Teaching”
What are complications of Ortho Surgeries?
●Infection (delays healing/Most common in open and soft tissue injuries)
●Venous Thromboembolism (VTE)
●Compartment syndrome
●fat embolism
●rhabdomyolysis
What fractures are most at risk for VTE and how can you try to avoid them?
●Hip/ Total Knee
● prophylactic anticoagulant drugs
●ROM (all extremities for circulation)
What is compartment syndrome & what are the causes?
●condition where swelling causes increased pressure within limited space (muscle compartment)
● long bone fracture, excessive soft tissue damage, crush injuries
●causes: casts, restrictive dressings, IV infiltration, closing fascia too early
Nursing Considerations for Compartment Syndrome?
● At least one of the P’s will be present…especially PRESSURE.
●early recognition/ prompt dx is critical to prevent permanent damage to muscles and nerves.
●Relieve pressure
●DO NOT elevate the leg above the heart. (We need circulation to the area)
●DO NOT apply cold compress. (Vasoconstriction)
●Fasciotomy: surgical decompression may be needed
What is Fat Embolism Syndrome? What are the clinical manifestations/nursing considerations?
●characterized by fat globules entering the circulatory system from fractures.
Clinical manifestations:
●Respiratory distress
●Petechiae
●No labs test will diagnosis
●Nursing considerations: supportive and related to managing symptoms
●Early recognition is crucial to prevent death!
What is rhabdomyolysis? What are the S/S? Test question for sure
●Syndrome caused by breakdown of damaged skeletal muscle cells.
●Releases myoglobin into bloodstream
●S&S: dark reddish or brown urine (kidney failure), muscle pain, muscle weakness, elevated Creatine kinase (tx: hydration)
What are the most common reasons for Amputations and their diagnostic studies/types?
● Most common reason: PVD, diabetes Pt’s
●Dx studies: arteriography (vascular test), doppler studies, and a venography (tells info about circulation.)
●Types:
●AKA (above knee)
●BKA (below knee)
What are nursing considerations for amputee patients? 
● A lot of psychosocial care (include family)
●Assess dressing and change as needed. (Dr will do 1st change!)
●Keep surgical torniquet available for emergency use
●Prevent flexion contractures (ROM, avoid sitting for long periods, lay prone for 30min 3-4x/day)
●Proper bandaging
●PT with crutch walking
What is some Pt education for amputations?
•infection/what to look for (Temp, redness, swelling, drainage, smell(
•discourage semi-fowler’s
•educate about phantom limb pain and how to tx it.
•asses for skin breakdown/ irritation
What are some medications for pain relief? (NSAIDs - what are they? Adverse effects?)
NSAIDS: Work by inhibiting COX, the enzyme that form prostaglandins. This leads to decreased inflammation and pain.
●Ibuprofen/Motrin
●Toradol
●Naproxen (look for blood in stool)
Adverse Effects: Gi bleeds, constipation, kidney problems, stomach upset/ulcers, HTN
What are some medications for pain relief (OPIODS - COMBO ANALGESICS, adverse effects/ nursing considerations?)
Opioid Analgesics:
●Morphine
●Fentanyl
●Dilaudid
●Hydrocodone
●Oxycodone
Combo Analgesics:
●Norco
●Percocet
●Vicodin
●Tylenol with Codeine
●Adverse effects: addiction, increased need for fiber/fluids (constipation), take stool softener
●Nursing Considerations: don’t drive
What are some medications for pain relief? (MUSCLE RELAXANTS- what are they, adverse effects?, nursing considerations)
●Muscle Relaxants: used to treat localized muscle spasms after injury or surgery
●Baclofen
●Soma
●Flexeril
●Adverse effects: hepatotoxicity, addiction
●Nursing considerations: don’t drive
What are some post amputation considerations?
●most important as nurse: prevent infection/ provide psychosocial support
●Mobility:
●PT
●learning to walk with prosthesis (if applicable)
●learning to walk with crutches
●balance
Psychosocial:
●grieving a loss
●identity issues
●self-esteem
●caregiver strain (very common)
●financial strain (very common)
*Table 62.14 (pt/caregiver teach amputation)
Back pain overview
●Back pain is the 2nd most common cause of pain (1st is headache)
●Acute (4wks or less) vs. Chronic (more than 3 months)
●Radicular (sciatica- nerve root) vs. Referred (not related to back- kidneys for ex.)
●Good body mechanics prevent injury
What is acute lower back pain? (Causes, Tx?)
●Last 4 weeks or less
●Caused by trauma or activity
●Symptoms often appear 24 hours or later due to the gradual increase in pressure on the nerve or disc
●Tx: gabapentin, steroids, opioids, NSAIDs
●Alternative tx: (hospital): hot/cold compress, binder, rest 1-2 days. (Home): stretch, massage, acupuncture, cupping
What is chronic lower back pain? (Causes, Tx?)
Last more than 3 months, or involves repeated episodes
●Cause can be undetermined
●Common causes:
●Degenerative conditions
●Bone diseases (do x-ray, CT, MRI)
●Weakness from scar tissue or injury
●Chronic strain
●Congenital spine problems
●Tx: similar to acute:
●NSAIDS, antidepressants, Neurontin
What are the diagnostic studies often used?
●X-ray
●MRI
●CT scan
●EMG (electromyography/ severity of nerve irritation)
●Straight leg test
●Crossed SLR test
What are two surgical treatments for back pain?
●Laminectomy: common, traditional procedure for lumbar disc disease.
●Discectomy: small instruments used to decompress the nerve root. Minimal bleeding, easier recovery. (1-2 days of rest)
Explain Spinal Disc Replacement
●Provides ability to replaced an injured disc w/o performing a fusion surgery.
●Possibly slows degenerative process in the adjacent discs.
●Risk for failure of correction due to the synthetic material
●Not commonly done (to replace the whole disc)
Explain Spinal Disc Fusion
● Fusion may be recommended for patient’s with instability (won’t be recommended for older Pt’s)
●As body heals, the bone graft and vertebrae grow into one unit (or become fused)
●This stabilizes the vertebrae which may decrease pain with movement
What is the Post-op Care for back surgery?
●Neuro checks, VS
●Skin checks
●Wound assessment
●Halo sign (blood on dressing, circle and date, call Dr immediately could be emergent bleed)
●Keep supine x 24 hours if possible
●Get help turning & repositioning!
●Discharge teaching (prevent infection, importance of ambulation, limitations!!)
