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Clinical Nursing May Exam > Orthopaedics > Flashcards

Orthopaedics Flashcards

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1
Q

what is included in history for equine lameness workup?

A 
signalment
use of horse
length of ownership
exercise
feeding
shoeing
housing
previous conditions
limbs affected
onset and progression of signs
previous treatment
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2
Q

what are aims of equine workups in horses?

A 
determine if lame or sound
identify limbs affected
score lameness
identify source and cause
treatment decision
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3
Q

what are the stages of equine lameness workup?

A 
clinical exam
body condition
assessment of limbs
weight bearing 
posture
swellings
focused MSK exam
gait evaluation
flexion tests
exam of affected limb
nerve blocks
imaging
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4
Q

what are parts of the specific MSK exam of equine lameness workup?

A

inspection
palpation
manipulation

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5
Q

what PPE is needed for working with horses?

A

hard hat
steel toe cap boots
gloves
overalls

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6
Q

how is horses gait evaluated?

A 
identify abnormalities 
potential causes
degree of lameness
affected limb
walking and trotting up
lunging
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7
Q

describe how to recognise forelimb lameness in horses

A

assessed when horse walking towards

head non with head up as lame leg hits ground

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8
Q

describe how to recognise hindlimb lameness in horses

A

assess walking away

hip of lame limb rises and falls with greater range of motion

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9
Q

what is the purpose of grading lameness?

A

assess improvement or regression

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10
Q

what is lameness locator?

A

sensors on horse help identify lame limb

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11
Q

what can be observed to help identify lameness in horses?

A

length of strides
arc and path of foot flight
foot placement

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12
Q

what are uses of flexion tests in horses?

A

demonstrate and exacerbate mild lameness

localise lameness

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13
Q

describe horse flexion test

A

limb held flexed for 1 minute
trotted away as soon as limb released
observe for lameness with few lame strides normal

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14
Q

state limitations of horse flexion tests

A

hard to flex only one joint so lack of specificity
can have false results
inconsistent results

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15
Q

why can lunging help determine lameness?

A

inside leg lameness worse on circle

hard ground makes worse

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16
Q

what are considerations when lunging horses?

A

PPE
does horse lunge well
location

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17
Q

what is the purpose of nerve blocking to test for lameness in horses?

A

identify area of lameness by blocking distal to proximal

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18
Q

describe how nerve blocks are performed in horses

A

clean with chlorhex and spirit
place blocks medial and lateral
leave for 10 minutes then trop up looking for improvement

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19
Q

what nerve and joint blocks are performed in horses?

A

nerve- palmer/planter digital, abaxial sesamoid, low point 4

joint- intrasynovial

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20
Q

when is imaging done for equine lameness?

A

area of lameness already identified to interpret clinical findings

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21
Q

what is seen on radiographs for assessing lameness in horses?

A

bony changes

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22
Q

what can ultrasounds show regarding equine lameness?

A

tendon and ligament changes
lesions
peritendinous fluid in tendon sheaths

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23
Q

what is arthroscopy used for in equine lameness investigation?

A

direct visualisation of joint cavities including articular cartilage, synovial membrane, menisci

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24
Q

how does CT and MRI benefit equine lameness investigation?

A

cross sectional imaging of complex structures

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25
Q

how is nuclear scintigraphy used for equine lameness investigations?

A

substance injected IV taken up to bone with higher uptake in areas of high turnover
emits gamma radiation to show areas of injury

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26
Q

what is equine synovial sepsis?

A

bacterial contamination of synovial structure

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27
Q

what happens if equine synovial sepsis is untreated?

A

septic arthritis

chronic lameness

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28
Q

describe investigations for equine synovial sepsis

A

synoviocentesis
analysis of synovial fluid
contrast radiography

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29
Q

what are roles of nurses for arthrocentesis?

A

prep site
non-sterile assistant
prepare equipment
monitor for lameness for 2 days after

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30
Q

what equipment is needed for arthrocentesis?

A

needles
syringes
sterile gloves
collection tubes

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31
Q

what is looked at in arthrocentesis samples?

A

cytology
protein concentration
lactate
culture

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32
Q

define laminitis

A

inflammation of lamella in hoof

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33
Q

what is the effect of laminitis?

A

dermal and epidermal separation

rotation or sinking of P3

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34
Q

describe the phases of laminitis

A

developmental between trigger and clinical signs
acute onset of clinical signs for 72 hours
subacute from 72 hours
chronic structural failure

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35
Q

list clinical signs of laminitis

A 
pottery gait
bounding digital pulses
leaning on heels
recumbency
struggling to turn
reluctance to pick up feet as usually bilateral
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36
Q

what are causes of laminitis?

A 
PPID
EMS
excess carbohydrates
endotoxemia
corticosteroids
not fully understood
excess weight bearing on one limb due to disease in other limb
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37
Q

what is the likely cause of laminitis due to endocrinopathies?

A

hyperinsulinemia

insulin toxicity

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38
Q

list risk factors for laminitis?

A 
history of laminitis
obesity
endocrinopathies
season
native ponies
excess carbs
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39
Q

how is developmental laminitis managed?

A 
intervene before clinical signs if at risk
cold therapy to reduce perfusion
NSAIDs
frog supports
deep shavings bed
long term management
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40
Q

how is acute laminitis managed?

A 
strict box rest
deep shavings bed
frog supports
NSAIDs
treat underlying cause
reduce carbs if endocrine related
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41
Q

how is sub acute laminitis managed?

A

gradually withdraw treatment when improving

strict box rest

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42
Q

how is chronic laminitis managed?

A

shortening toe over time

remedial shoeing

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43
Q

how can radiography assess laminitis?

A

measure rotation and sinking

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44
Q

how can you try to prevent laminitis?

A 
control risk factors
treat endocrinopathies
exercise when possible to increase insulin sensitivity
keep ideal BCS
reduced carbs
restricted grazing
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45
Q

what is box rest for horses?

A 
stabling in confined space
no exercise or turnout
monitor faecal output
check for colic
monitor behaviour
gradually turnout and introduce exercise
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46
Q

what are GI considerations for box resting?

A

management changes can cause colic
reduced exercise can cause reduced gut motility
ulcers caused from reduced eating times

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47
Q

what are behavioural considerations for box resting?

A

stereotypies
stable mates if possible
increased energy

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48
Q

define first aid

A

emergency care given immediately to injured individual

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49
Q

what is the purpose of first aid?

A

minimise injury and future disability
keep victim alive
prevent suffering and deterioration

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50
Q

why do you need to assume life threatening injury in trauma patients?

A

most from RTA

likely have thoracic or abdominal injury

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51
Q

what is the purpose of primary survey for trauma patients?

A

identify and treat life threatening injury

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52
Q

what is assessed in primary survey?

A 
airway patency
breathing rate, effort
circulation, MM, CRT, HR, temperature
external haemorrhage
CNS
shock
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53
Q

what are the stages of shock?

A

compensated
early decompensated
late decompensated

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54
Q

list signs of compensated shock

A 
tachycardia
tachypnoea
CRT less than 1 second
normal mentation
normal BP
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55
Q

list signs of early decompensated shock

A 
tachycardia
tachypnoea
pale MM
slow CRT
weak pulse
poor mentation
hypotension 
peripheral vasoconstriction
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56
Q

list signs of decompensated shock

A

bradycardia
absent CRT
cheyne stokes breathing
death

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57
Q

when is secondary survey carried out in trauma patients?

A

after successful resus and stabilisation

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58
Q

what is assessed in secondary survey?

A 
airways
CRT
pulse 
BP
lungs
abdomen
spine
head
pelvis
limbs
nerves
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59
Q

state signs of orthopaedic injury

A 
recumbency
lameness
limb wounds, pain, abnormalities
abnormal mobility
crepitation
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60
Q

list examples of orthopaedic injury

A 
fractures
luxation
wounds penetrating joints
tendons and ligament injury
muscle lacerations
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61
Q

define luxation

A

complete disruption of normal relationship between articular joint surfaces

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62
Q

define subluxation

A

partial disruption of relationship between articular surfaces

63
Q

define fracture

A

disruption in cortical continuity of bone

64
Q

how are open fractures initially treated?

A

as lacerations so apply sterile hydrogel to exposed bone
sterile support dressings to restore normal anatomy
cage confinement
antibiotics
analgesia

65
Q

how are bleeding wounds treated?

A

sterile contact layer applied
generous padding
absorbent layer
pressure for 30-60 minutes if artery bleed

66
Q

what is the benefit of reducing fractures?

A

aid comfort

reduce further tissue injury

67
Q

how are closed fractured initially treated?

A

support dress limbs

68
Q

what are components of support dressings?

A

soft padding
splinting
conforming layer
protective layer

69
Q

what is the purpose of bandaging wounds?

A

prevent self trauma and contamination
support fracture
control swelling
immobilise

70
Q

where are support dressings mainly used?

A

distal limbs

support proximal and distal joints around injury

71
Q

how are upper limb fractures managed?

A

cage rest before surgical repair

72
Q

what are the aims of nursing fracture patients?

A

return patient to normal function

allow bone healing

73
Q

what are advantages of conservative fracture management?

A

reduced anaesthesia
no need for surgery
cheaper

74
Q

what are disadvantages of conservative fracture management?

A 
cost more if doesnt heal and needs surgery
immobility causing fracture disease
incorrect healing
cast sores
ischemia
75
Q

what are principles of conservative fracture management?

A

surrounding soft tissue provides sufficient stability to keep bones aligned
minimise movement
provide analgesia

76
Q

what fractures are suitable for conservative fracture management?

A

some pelvic, scapula and vertebral

minimally displaced fractures

77
Q

how should owners care for conservatively managed fracture pateints?

A 
good cage size
manage boredom
assist ambulation
non-slip rugs
normal requirements
regular check ups
78
Q

how does external coaptation work?

A

compression transmitted to bones by soft tissues

79
Q

what happens if pressure is unevenly distributed in external coaptation?

A

circulatory stasis

80
Q

what fractures may be suitable for external coaptation?

A

distal to elbow or stifle
stable fractures
50% overlap of fragments on radiographs
other bones around to support fractured bone

81
Q

what are examples of external coaptation?

A

casts

splints

82
Q

how is external coaptation applied?

A

double layer stockinette placed with top and bottom overlapping
sofban in 1 or 2 layers
cast material applied under some tension in 3 up 3 down layers
cut cast medial and lateral
tape together cast
fold over sofban and stockinette and tape down
cover whole bandage in cohesive bandage
check toe nails and central pads visible but not protruding

83
Q

list complications of non-surgical fracture management

A 
ischemia
necrosis
cast sores
incorrect healing
fracture disease
84
Q

what are examples of fracture disease?

A 
joint stiffness
muscle atrophy
osteoporosis
muscle contracture
fibrosis
85
Q

how can fracture disease be avoided?

A

rapid return to weight bearing
limit un needed immobilisation of joints
consider other treatment options

86
Q

state some discharge instructions for external coaptation

A

cast care

informed of complications

87
Q

what is nursing roles for surgical fracture management?

A 
pre-op analgesia and care
surgical prep
surgical assistance
post op care
discharge
88
Q

how do nurses assist during fracture surgery?

A

manage instruments

position and prepare patient

89
Q

define fracture reduction

A

process of replacing fracture segments in original anatomical position

90
Q

how is closed reduction done?

A

traction
counter traction
manipulation
bending

91
Q

what fractures are suitable for closed fracture reduction?

A

open
recent
stable

92
Q

what is meant by toggling?

A

repairing transverse fractures by bending 180 degrees, engaging ends and straightening limb

93
Q

list examples of ortho implants

A 
pins
wire
screws
external fixation 
plates
94
Q

how are intermedullary pins usually used?

A

in combination with plates, ESF, wire

95
Q

what are complications associated with using intermedullary pins?

A

if too short hard to retrieve
seroma if too long
loosening
migration

96
Q

how are interlocking nails used?

A

as medullary pin locked in place with screws

97
Q

what is the purpose of interlocking nails?

A

prevent rotation and axial collapse

98
Q

what is the purpose of bone plates?

A

restore bone structure to restore weight bearing function and allow healing

99
Q

how do bone plates work?

A

compress bone fragments
share load between bone and plates for support
bridging fractures

100
Q

what are uses of bone screws?

A

cancellous bone fractures

combined with plates and interlocking nails

101
Q

list types of bone screws

A

locking
self tapping
non self tapping

102
Q

what is the function of bone screws?

A

secure plate to bone

compress bone fragments

103
Q

how are articular fractures treated?

A 
open reduction 
internal fixation
compression 
reduction
maintaining joint mobility
104
Q

what is the different between negative and positive profile pins?

A

negative has thread cut out but positive has thread around pin

105
Q

what are components of ESF?

A 
pins
interface pins which are rougher to help bind to putty
connecting bars
putty
clamps
IM pins
106
Q

what are benefits to putty connecting ESF?

A

light
no limit to size or closeness
no pins protruding

107
Q

what are drawbacks to putty connecting ESF?

A

may be harder to remove

108
Q

what are advantages to clamps connecting ESF?

A

reusable

easier to remove and adjust

109
Q

what are disadvantages to clamps connecting ESF?

A

need correct alignment

limit to pin and bar size

110
Q

how are avulsion fractures treated?

A

pin and tension band to hold together

111
Q

what places are avulsion fractures found?

A

olecranon
greater trochanter
acromion
tibial tuberosity

112
Q

how do surgical assistants aid ortho surgery?

A 
manage instruments
assist retraction
manage samples
manage bone grafts
count swabs
113
Q

what is post op care for ortho patients?

A 
post op x rays
cage rest
general care
suture removal
buster collar
physio
114
Q

what are potential complications post ortho surgery?

A

premature closure of growth plates
poor fracture healing
lameness
pepper kinks

115
Q

what is hip dysplasia?

A

developmental disease so laxity develops in joint capsule resulting in hip subluxation

116
Q

state aetiology for hip dysplasia

A

genetics
diet
size of animal
exercies

117
Q

what is signalment for hip dysplasia?

A

large breeds
laxity at 6-7 months old
osteoarthritis in adults

118
Q

list clinical signs of hip dysplasia

A 
short stride
stiffness
clunking hips
lateral swap
hopping
adducted limb
pain on extension
muscle atrophy
crepitus
119
Q

how is hip dysplasia diagnosed?

A 
ventrodorsally extended x-rays
hip subluxation
acetabular remodelling
osteophytes
ortolani test to test laxity
120
Q

how can you manage hip dysplasia non-surgically?

A 
OA management
NSAIDs
rest
diet
hydrotherapy
121
Q

how can you surgically manage hip dysplasia?

A

growth plate fusion
pelvic osteotomy
total hip replacement
femoral head and neck excision

122
Q

what are causes of avascular necrosis of femoral head?

A

trauma
ischemia
small breed dispositions
genetics

123
Q

list clinical signs of avascular necrosis of femoral head

A

unilateral hindlimb lameness
pain on hip extension and flexion
muscle wastage

124
Q

how is avascular necrosis of femoral head diagnosed?

A

imaging showing lucency, collapse, mushrooming

125
Q

how is avascular necrosis of femoral head treated?

A

cage rest
femoral head and neck excision
total hip replacement

126
Q

what is prognosis for avascular necrosis of femoral head?

A

guarded

usually need salvage surgery

127
Q

state clinical signs of slipped capital femoral epiphysis

A

lameness

hip pain

128
Q

what are radiographic changes seen for slipped capital femoral epiphysis?

A

radiolucent line at capital physis
separation between femoral head and neck
reabsorption of femoral neck

129
Q

how is slipped capital femoral epiphysis treated?

A

femoral head and neck excision
total hip replacement
parallel pin

130
Q

what are causes of hip luxation?

A

trauma

hip dysplasia

131
Q

how is hip luxation diagnosed?

A 
sudden onset lameness
stifle out, hock in, leg adducted
craniodorsal luxation
imaging
pain 
crepitus
palpation
thumb displacement test
132
Q

how is hip luxation treated?

A

analgesia
closed reduction
stabilisation
open reduction

133
Q

how is hip luxation closed stabilised?

A

anaesthetise
extend, adduct and externally rotate to lift femoral head over dorsal acetabular rim
abduct and internally rotate to sit femoral head in acetabulum

134
Q

how can you do open reduction for hip luxation?

A

toggle
transarticular pin
prosthetic or primary capsular repair
ilio femoral suture

135
Q

what is prognosis for hip luxation?

A

good
OA will form
may re dislocate

136
Q

what is patella luxation?

A

displacement of patella from groove, usually medial

137
Q

what are causes of patella luxation?

A

developmental
hereditary
trauma

138
Q

how is patella luxation diagnosed?

A

not flexing and extending stifle
cowboy stance
patella clicking on manipulation
laxity of patella on extension

139
Q

what is grade 1 patella luxation?

A

patella normally within groove

returns spontaneously when manually luxated

140
Q

what is grade 2 patella luxation?

A

patella normally within groove

can be luxated and remain when released

141
Q

what is grade 3 patella luxation?

A

patella normally out of groove

can manipulate back into groove

142
Q

what is grade 4 patella luxation?

A

patella normally outside of groove

cant be reduced by manipulation

143
Q

how can patella luxation be treated?

A

tibial tuberosity transportation to realign within groove
deepen trochlear groove
release of soft tissue

144
Q

what is post op care for patella luxation?

A

analgesia
6 weeks strict rest
gradually increase exercise

145
Q

what is prognosis for patella luxation?

A

worse with increased grade
good in small dogs
high risk of complications in large dogs

146
Q

what is the purpose of cranial cruciate ligament?

A

limit cranial drawer, hyperextension and internal rotation

147
Q

what causes cranial CLD?

A

trauma
degeneration
inflammatory arthopathy
angled tibial plateau by growth abnormality

148
Q

what is the anatomy of cruciate ligaments?

A

caudolateral band- tight in extension

craniomedial band- always tight

149
Q

how is cranial CLD diagnosed?

A 
signalment
gait analysis
stifle pain
crepitus
instability
effusion
cranial drawer test
tibial thrust test
imaging
150
Q

how is cranial CLD treated?

A

conservative
TPLO to flatten tibial plateau
fabello tibial sutures to replace ligament

151
Q

what is post op care for treating cranial CLD?

A

NSAIDs for 14 days
opioids for 2 days
physio

152
Q

what is prognosis for correction of cranial CLD?

A 
doesnt cure
slows process of arthritis
some risk of complications
likely to have OA in later life
50% have meniscal injury
153
Q

how do you treat meniscal injuries?

A

arthrotomy at CCLD surgery
debride torn portion
leave unaffected meniscus

Clinical Nursing May Exam (22 decks)

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