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NCLEX > Ortho > Flashcards

Ortho Flashcards

1
Q

S/S of fx

A 
Unnatural movement
Deformity possible
Shortening of extremity cause by muscle spasm
Crepitus
Swelling, pain
Discoloration
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2
Q

What do you worry about with fx

A

Compartment Syndrome

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3
Q

Tx of fx

A

Immobilize bone ends plus the adjacent joints
Support above and below site
Move as little as possible
Splints prevent fat emboli and muscle spasm

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4
Q

What do you do with open fx

A

Cover with something sterile

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5
Q

Most important thing for fx

A

Neurovascular checks

  • Pulses
  • Color
  • Movement-neuro
  • Sensation-neuro
  • Cap refill
  • Temp
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6
Q

Complication of fx

A

Shock (hypovolemic)
Fat embolism
Compartment syndrome

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7
Q

What type of fx do you see fat embolisms with?

A

Same ones that can lead to shock: long bones (femur), pelvic, crushing injuries

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8
Q

S/S of fat embolism depend on what?

A

Where the fat embolus goes

  • Petechiae or rash over chest
  • Conjunctival hemorrhages
  • Snow storm on CXR
  • Young males
  • First 36 hours
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9
Q

Compartment syndrome

A

Increased pressure within a limited space, fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes swollen and hard and the client complains of sever pain that isn’t relieved with meds

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10
Q

Pain with compartment syndrome

A

Unpredictable, disproportionate to injury

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11
Q

If compartment syndrome is undetected, what may result?

A

Nerve damage and possible amputation

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12
Q

Common areas of compartment syndrome?

A

Forearm and Quadricep

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13
Q

Prevention of compartment syndrome

A

Elevate extremity, soft cast then rigid cast

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14
Q

Tx of compartment syndrome

A

Loosen cast to restore circulation
Be careful picking answer “remove cast”
Cas cutters to remove cast: instruct client that the cast saw doesn’t touch skin, but it does vibrate
Fasciotomy- doc cuts down into tissue to relieve pressure

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15
Q

Before a cast is removed, what must happen?

A

They must have really bad NV checks

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16
Q

Cast care for plaster and fiberglass casts

A

Ice packs on the side, not top, for first 24 hours, it’s still wet
No indentations
Use palms of hands for first 24 hours, it’s still wet
Keep uncovered and allow for air drying
Don’t rest cast on hard surface or sharp edge, rest on soft pillow, no plastic bc plastic holds heat
Mark breakthrough bleeding: circle area, date and time site
Cover cast close to groin with plastic once it is dry
NV checks with 5 Ps

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17
Q

What do you do if the client with a cast complains of pain?

A

NV check

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18
Q

Most pain with cast clients is relieved how?

A

Elevation, cold packs and analgesics. If they don’t relieve the pain, think complication

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19
Q

Fiberglass cast

A

More common than plaster
Advantageous bc they’re lightweight, waterproof and stronger than plaster
Provides earlier wight bearing than plaster

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20
Q

Traction info

A

Decreases muscle spasms, reduces (realigns) and immobilizes
Continuous
Weights should hang freely, don’t touch bed or floor
Keep client pulled up in bed and centered with good alignment
Exercise non-immobilized joints
Ropes should move freely and knots should be secure
Special air filled foam mattress

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21
Q

Skin traction

A

Used short term to relieve muscle spasms and immobilize until sx
Tape, a boot, splint, or some type of material is stuck to the skin and the weights pull against it
Skin is not penetrated
Do good skin assessments

22
Q

Can you insert anything into a cast?

A

NO, not even something soft. To relieve itching, apply cool, cool blowing

23
Q

Common type of skin traction

A

Buck’s, used with hip and femoral fx

24
Q

When can you relieve traction?

A

Only with a doc order

25
Q

Skeletal traction

A

Applied directly to bone with pins and wires
Used when prolonged traction is needed
Must monitor the pin sites and do pin care

26
Q

Pin care

A

Sterile
Remove crusts!
Serous drainage is okay

27
Q

Types of skeletal traction

A

Steinman, Crutchfield, Gardner-Wells tongs, Halo vest

28
Q

What do you do if the client is sliding down in bed and the weights are almost touching the floor?

A

Have a friend come help and lift weights while you pull the client up

29
Q

Pre op total hip replacement

A

Buck’s traction is used frequently

30
Q

Post op total hip replacement

A

NV checks
Monitor drains, don’t want fluid to accumulate in tissues
Firm mattress, joints need support
Over-bed trapeze to build upper body strength
Position: neutral rotation-toes to ceiling, limit flexion, we want extension of hip, abduction
Isometrics (squeeze muscles)
Trochanter roll to prevent external rotation, document
No weight-bearing until ordered by doc
Avoid crossing legs or being over
Do not sleep on operated side
Hydration
Stresses to new hip joint should be minimal in first 3-6 months
No pain meds in operative hip

31
Q

How to prevent foot drop

A

Foot drop boot or high top tennis shoes

32
Q

Anytime you’ve got somebody with an ortho or joint problem, what type of mattress do they need?

A

Firm for support

33
Q

What do you do if one of a clients pins is laying on the floor when you walk in?

A

Immobilize leg, call doc. You take over the roll of the pin

34
Q

Complications of total hip replacement

A

Dislocation
Infection
Avascular Necrosis
Immobility problems

35
Q

Dislocation with total hip replacement

A

Circulatory and nerve damage

S/S: shortening of leg, abnormal rotation, can’t move extremity, PAIN

36
Q

Infection with total hip replacement

A

Prophylactic ABX, just like with heart valve

Remove foley and drains ASAP

37
Q

Avascular necrosis

A

Death of tissue due to poor circulation

38
Q

Client education follow total hip replacement

A

Walking and swimming are best exercises
Avoid flexion: low chairs, traveling long distances, sitting more than 30 minutes, lifting heavy objects, excessive vending or twisting, stair climbing

39
Q

Total Knee Replacement (Arthroplasty)

A

Continuous passive motion
Keeps knee in motion and prevents formation of scar tissue
PT sets matching to gradually increase flexion and extension of knee
Never hyperextend or hyper flex knee
NV checks
Pain relief

40
Q

Where are amputations performed?

A

Most distal point that will heal, surgeon tries to preserve the knee and elbow

41
Q

Immediate post op care for amputations

A

Keep tourniquet at bedside
Elevation is controversial bc hip contractures. If ordered, only elevate for short time to reduce swelling
Don’t elevate on pillow, use foot of bed
Prevent hip/knee contractures with extension
Inspect residual limb daily to be sure that it lies completely flat on the bed
Phantom pain: seen more with AKA’s, usually subsides in 3 months

42
Q

First intervention to decrease phantom pain

A

Diversional activities

43
Q

Why is limb shaping important with amputations

A

For a prosthetic

44
Q

How do you want the stump shaped at the end of an amputation

A

Cone

45
Q

What is worn under the prosthesis for amputations?

A

Limb sock

46
Q

Why is it important to strengthen the upper body with amputations

A

They will be using crutches or a walker to ambulate

47
Q

Is it okay to massage the stump of an amputation?

A

Yes, promotes circulation and decreases tenderness

48
Q

How do you teach a client to toughen the stump with an amputation?

A

Press into a soft pillow, then a firm pillow, then the bed, then a chair

49
Q

Walkers

A

Walk into a walker

50
Q

Crutches

A

Should be 1-2 inches below axilla to prevent risk of brachial nerve damage
When ambulating, it’s up with the good leg, down with the bad leg

51
Q

Use canes on which side of the body?

A

Strong side

NCLEX (14 decks)

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