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COMPREHENSIVE PHASE > Orthopedic Nursing > Flashcards

Orthopedic Nursing Flashcards

1
Q

total bones in adult

A

206 bones

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2
Q

total bones in newborn

A

270 bones

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3
Q

breast plate

A

sternum

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3
Q

collarbone

A

clavicle

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4
Q

5 Flat bones

A

-sternum
-clavicle
-scapula
-skull
-pelvis

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5
Q

shoulder blade

A

scapula

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6
Q

lateral curvature of the spine

A

Scoliosis

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7
Q

common in female teenagers (screening ageg)

A

Scoliosis

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8
Q

confirmatory test for Scoliosis

A

X-Ray

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9
Q

Priority in patients with Scoliosis

A

Pulmonary Impingement (breathing)

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10
Q

test for Scoliosis when the patient’s body is lateral to the floor to determine if scapula is elevated and a/symmetrical

A

Adam’s Forward Bend Test

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11
Q

Main reason why the bones decrease as the age increases

A

Fusion of the bones

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12
Q

2 Management for Scoliosis

A

Milwaukee Brace
Harrington Rod Insertion

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13
Q

How many years is Milwaukee brace worn?

A

3 years

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13
Q

How many hours is Milwaukee brace worn?

A

23 hours
1 hour - hygiene and swimming

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14
Q

What is the priority on patients with Milwaukee Brace?

A

Prevent Skin Breakdown

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15
Q

Is it allowed to put lotions and creams to the skin of a patient with Milwaukee brace?

A

Do not apply anything on skin unless until prescribed!

-Brace not direct contact on skin

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16
Q

management for Scoliosis to lessen curvature and muscle spasms

A

Milwaukee Brace

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17
Q

Regions of the Spine

A

CTLSC

Cervical
Thoracic
Lumbar
Sacral
Coccyx

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18
Q

Posterior thoracic curvature of the spine

A

Kyphosis

[kpt]

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19
Q

curvature of the spine common in elderly

A

Kyphosis

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20
Q

curvature of the spine common in pregnant

A

Lordosis

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21
Q

Slip Disc

A

Herniated Nucleus Pulposus

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21
Q

anterior lumbar curvature of the spine

A

Lordosis

[lal]

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21
Q

Long Bones

A

Humerus, Radius, Ulna

Femur, Tibia, Fibula

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22
Q

long bones in the lower extremity

A

Femur, Tibia, Fibula

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23
Q

long bones in the upper extremity

A

Humerus, Radius, Ulna

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24
Q

4 Most Common Joints

A

Shoulder, Elbows, Hips, Knees

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25
Q

2 Ball and Socket Joint

A

Glenoid process
Acetabulum

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26
Q

Socket where humerus is connected

A

Glenoid process

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26
Q

Socket in pelvic girdle where femur is connected

A

Acetabulum

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26
Q

Elbows and Knees are which type of joints?

A

Hinge Joints

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27
Q

Shoulder and Hips are which type of joints?

A

Ball and Socket Joints

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27
Q

Joints that can only do flexion and extension

A

Hinge Joints
(elbows, knees)

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28
Q

Joints that can do range of motion, adduction/abduction, etc.?

A

Ball and Socket Joints
(Shoulder and Hips)

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29
Q

to fit or measure the length of the assistive device

A

Greater Trochanter

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30
Q

Bones that contain YELLOW MARROW

A

Long Bones

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31
Q

handle of the assistive device must be at the level of________, ______flexion.

A

Greater Trochanter,
20-30degree flexion

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32
Q

Priority when flat bones are affected

A

Flat bones: Bleeding

(red marrow)

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32
Q

Bones that contain RED MARROW that produces RBCs

A

Flat bones

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33
Q

Priority when long bones are affected

A

Long bones: Respiratory/Breathing

(yellow marrow consist of fats that may cause pulmonary embolism)

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34
Q

most common fracture in elderly

A

Hip Fracture

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35
Q

ball and socket away from center

A

Abduction

“aBukaka”

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35
Q

Why is there a need to promote extension of extremity?

A

To prevent contractures or fixation of joints (dikit)

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35
Q

ball and socket towards the center

A

Adduction

“aDikit”

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35
Q

Best position for Hip Fracture to prevent dislocation of joints

A

Abduction / Place pillows

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36
Q

Patient with Hip fracture:

____mattress
____toilet seat

A

-firm mattress
-high toilet seat

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37
Q

type of bed and position for patient with Hip Contractures

A

Soft Bed
Prone before sleep
(to promote extension)

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38
Q

Best position

A

Abduction and Extension

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39
Q

where is weight given when using crutches

A

hands or arms

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39
Q

how many inches shall be the placement of axillary bar of the crutch in relation to the axilla

A

2-3 inches below axilla

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40
Q

What is the complication common in crutches?

A

Crutch Paralysis /
Brachial Plexus Paralysis

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41
Q

Best site for bone marrow aspiration

A

Posterior ileac crest

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42
Q

Secondary best site for bone marrow aspiration

A

Anterior ileac crest

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43
Q

site of bone marrow aspiration for 1 year old

A

Tibia

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44
Q

connects the bones to muscles

A

Tendons

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45
Q

connects the bone to bone

A

Ligaments

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45
Q

damage of tendons

A

sTrain

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46
Q

damage of ligaments

A

sprain

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47
Q

white, avascular tissue that covers the bones

A

cartilage

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48
Q

damage of cartilage

A

Osteoarthritis

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49
Q

damage of bones

A

Fractures

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49
Q

Common Injury Management

A

PRICE
“Splint”
X HARM

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49
Q

PRICE

A

Protect
Rest
Ice
Elevate

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50
Q

X HARM

A

No:

Heat Application / Warm Compress
Alcohol
Running Activity
Massage

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51
Q

TO PROTECT affected upper extremities

A

Sling

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52
Q

TO PROTECT affected lower extremities

A

Crutches

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52
Q

Rest the affected extremity
(not so restrictive)

Purpose: promote HEALING

A

Relative Rest

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52
Q

used to support and immobilize, and promote extension

A

Splinting

such as when coughing, or IV insertion site

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53
Q

Complication of Bed Rest

A

Immobility

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53
Q

How to prevent pressure ulcers or bedsores

A

turn the patient every 2 hours

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54
Q

How to prevent Deep Vein Thrombosis

A

wear elastic compression stockings

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54
Q

Management for Deep Vein Thrombosis

(+) Homan’s sign

A

NEVER Massage
Refer to the Doctor!

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55
Q

Drug of Choice for Deep Vein Thrombosis

A

Heparin

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55
Q

Management for Contractures (flexor)

A

Range of Motion (ROM)

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55
Q

Management for Boredom

A

Give Cellphone

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55
Q

How to prevent pneumonia

A

Coughing and Deep breathing

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56
Q

When the calcium cannot enter the bones leading to what electrolyte imbalance and disease condition

A

Hypercalcemia
Osteoporosis

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56
Q

Nursing management for Osteoporosis

A

Increase OFI (can have renal calculi)

Turn every 2 hours

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57
Q

Indication for Ice

A

-Swell (shrinks tissue)
-Pain (numbness)
-Prevent bleeding (vasoconstrict)

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58
Q

bleeding in the VEIN

A

Apply Direct Pressure on wound

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58
Q

(+) Internal Bleeding

A

ELEVATE!!!

DO NOT give ice.
(Can coagulate blood)

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59
Q

bleeding in the ARTERY

A

Apply Tourniquet before the wound ;

If possible, cauterize

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60
Q

Nursing Management for Hemophilia

A

Elevate

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61
Q

Do NOT apply HEAT / WARM COMPRESS if:

  2. 3.
A

[BSI]

  1. Bleeding tendencies
    (e.g. may cause rupture)
  2. Swelling (bc further swell)
  3. Infection (bc further spread)
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62
Q

Indication for Elastic Bandage

A

For Swelling
(more effective than ice)

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62
Q

Nursing Management for Hemarthrosis

A

Elevate

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62
Q

Indication for Elevate

A

For Edema

(promote venous return)

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63
Q

Dysmenorrhea management

A

Can apply heat/warm compress

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63
Q

Management for Pain

A

Heat application / Warm Compress

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64
Q

Alcohol can ____ healing process

A

delay

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64
Q

demineralization of the bone

A

Osteoporosis

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65
Q

2 hormones that helps in calcium regulation

A

Calcitonin , Estrogen

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65
Q

common in menopausal women

A

Osteoporosis

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66
Q

Normal Calcium Level

A

8.6 -10 mg/dL

4.5 - 5.5 meq/L

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66
Q

Fracture that is caused by underlying disorder

A

Pathological fracture

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67
Q

Needed for Calcium absorption

A

Vitamin D

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68
Q

Best site for Calcium Absorption

A

Ileum

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69
Q

3 needed for Calcium Metabolism

A

Calcitonin, Estrogen, Exercise

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70
Q

hormone produced by the parathyroid gland that releases calcium by bones into the bloodstream

A

Parathormone
↑ calcium levels

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71
Q

hormone produced by the thyroid gland that lowers calcium levels in the blood (not in the bones).

A

Calcitonin
↓calcium levels

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72
Q

responsible for bone resorption where bone tissues are broken down and calcium will go into the circulation

A

Osteoclasts

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72
Q

2 manifestations of Hypercalcemia

A

Osteoporosis
Renal Calculi

72
Q

responsible for production of new bone tissue that allows calcium to go into the bones

A

Osteoblasts

b= Build

73
Q

most common CAUSE of Hypercalcemia

A

Bed Rest

74
Q

cheek twitching seen in pts with Hypocalcemia

A

Chvostek Sign

74
Q

most dangerous complication of Hypocalcemia

A

laryngeal spasm (closure of larynx)

–> respiratory occlusion/arrest

74
Q

sign of Hypercalcemia

A

Signs related to kidney (e.g. low back pain)

-so need to increase OFI

75
Q

carpopedal spasm seen in pts with Hypocalcemia

A

Trousseau’s Sign
(more definitive)

75
Q

2 MAIN CAUSES OF HYPOCALCEMIA

A
  1. Post Thyroidectomy
  2. Renal Failure
76
Q

DOC for Post Thyroidectomy

A

Calcium Gluconate

76
Q

DOC for Renal Failure

A

Amphojel

(antacid with phosphate binder properties)

76
Q

which is more dangerous

Hypocalcemia vs Osteoporosis

A

Hypocalcemia

-so calcium in BLOOD is more important than going into bones

76
Q

Best sources of Calcium

A

Sardines and Dairy Products (milk, cheese, yogurt, ice cream)

77
Q

Which is better source of calcium: sardines or dairy products

A

Sardines

78
Q

BQ TIP:

Things to consider upon choosing the best Diet (Philippine setting)

A
  1. LOWER PRICE
  2. AVAILABILITY (Luzon - Mindanao)
79
Q

Best source of vitamin D

A

Food (tuna, mackarel, salmon)

80
Q

Activates vitamin D synthesis

A

Sunlight

81
Q

where is activated vitamin D stored?

A

Kidney

82
Q

How to prevent Osteoporosis

[HOW]

A

Hormonal Replacement of Estrogen

Oral Calcium & Vitamin D intake should be increased

Weight bearing exercises (walking, dancing jogging)

83
Q

Drug of Choice for Osteoporosis

A

Alendronate (Fosamax)

-inhibits resorption of Ca (calcium will not be released from bones)

84
Q

more rare but severe deficiency in Vitamin D

Softening of bones associated with bone pain

A

Osteomalacia

85
Q

Nursing management for Osteomalacia

A

Bed rest

86
Q

the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency

A

Rickets

87
Q

Parathormone : Calcium

A

Directly Proportional

↑Parathormone : ↑Calcium

88
Q

Phosphorus : Calcium

A

Inversely Proportional

↓Phosphorus: ↑Calcium

89
Q

Hyperparathyroidism:

A

Hypercalcemia

90
Q

2 manifestations of Hyperparathyroidism

A

Hyperparathyroidism: Hypercalcemia

-Osteoporosis
-Renal Calculi

90
Q

Hypophosphatemia:

A

Hypercalcemia

91
Q
A
91
Q
A
92
Q
A
93
Q
A
94
Q

Hyperphosphatemia:

A

Hypocalcemia

95
Q

inflammation of joints

A

Arthritis

95
Q

which is more dangerous, Hyperphosphatemia or Hypophosphatemia?

A

Hyperphosphatemia

-because it also equates to Hypocalcemia (which is more dangerous)

95
Q
A
95
Q
A
95
Q

autoimmune arthritis

A

Rheumatoid Arthritis

95
Q

degenerative type of arthritis

A

Osteoarthritis

95
Q

metabolic (food) arthritis

A

Gouty Arthritis

96
Q

causative pathogen of Rheumatoid Arthritis

A

Epstein Barr Virus

96
Q

common in females children

A

Rheumatoid Arthritis

97
Q

Inflammation of Synovial Fluids

A

Rheumatoid Arthritis

98
Q

classic sign of Rheumatoid Arthritis

A

Morning Stiffness

98
Q

Worsen with rest

A

Rheumatoid Arthritis

99
Q

normal characteristic of Synovial Fluid

A

clear

100
Q

confirmatory diagnostic tool for Rheumatoid Arthritis

A

Arthrocentesis:
(+) cloudy synovial fluid

101
Q

known as moveable joints

A

Synovial joints

101
Q

Blood test results for Rheumatoid Arthritis

A

(+) Rheumatoid Factor: Multiple Joint Affected

(+) Anti-nuclear Antibodies (ANA): Autoimmune

(-) Anti-nuclear Antibodies (ANA): Not autoimmune, Epstein Barr

↑ ESR: Severity

102
Q

early sign of nerve compression

A

(+) Pain

102
Q

later sign of nerve compression

A

Numbness

103
Q

best management for autoimmune RA

A

Steroids

104
Q

best management for virus-causing RA

A

(virus is self-limiting)

  • Increase OFI
  • Adequate rest
  • Vitamin C
105
Q

best management for bacteria-causing RA

A

Antibiotic

106
Q

which is more dangerous RA —cause is viral or bacteria?

A

Bacteria because virus is self-limiting

107
Q

symmetrical (bilateral), systemic

A

Rheumatoid Arthritis

108
Q

dryness in eyes, buccal mucosa, and vagina

seen in patients with RA

A

Sjogren’s Syndrome

109
Q

anemia, leukopenia, thrombocytopenia, and splenomegaly

seen in patients with RA

A

Felty’s Syndrome

110
Q

late sign of anemia

A

pallor

110
Q

normal RBC count

A

RBC : 4-6 million/microliter

111
Q

normal WBC count

A

WBC: 4,000-11,000

111
Q

management for anemia

A

REST

112
Q

Low WBC

A

Leucopenia

112
Q

classic sign of anemia

A

fatigue

113
Q

Low RBC

A

Anemia

114
Q

Nursing diagnosis for Leucopenia [RA]

A

Risk for infection
- no fever

115
Q

Management if:
Fever
↑WBC

A

(+) infection

REFER!

115
Q

Management for Leucopenia

A

Avoid crowded places
Avoid fresh food
Avoid raw food

116
Q

Low platelets

A

Thrombocytopenia

117
Q

Nursing diagnosis for Thrombocytopenia

A

Risk for bleeding

118
Q

Signs of Bleeding

A

-bruising
-ecchymosis
-hematoma
-petechiae

119
Q

relieve constipation and avoids valsalva maneuver

A

stool softeners (e.g. Dulcolax)

120
Q

Management for Thrombocytopenia

A

Avoid intrusive/invasive procedures

Avoid contact sports

Avoid Valsalva maneuver

Stool Softener

121
Q

normal platelet count

A

Platelet: 150,000 - 450,000 cells/microliter

122
Q

management for constipation

A
  1. Increase fiber
  2. Increase oral fluid intake
  3. laxative

x Enema - bowel preparation

122
Q

enlargement of the spleen

A

Splenomegaly

123
Q

[RA Deformity]

thickening of synovial fluid

A

Pannus Formation

123
Q

[RA Deformity]

fixation of joints

A

Bony Ankylosis

124
Q

fingers are bent abnormally - deformity in RA

A

Swan’s Neck

125
Q

hyperextension of the thumb - deformity in RA

A

Boutonniere

125
Q

Ulnar Deviation

A

Ulnar Deviation: Upper in

Normal ulna: upper out

126
Q

Ulna

A

Upper In

126
Q

UTIN

A

Ulna, Tibia: IN

Radial, Fibula: OUT

127
Q

Tibia

A

Lower In

128
Q

Fibula

A

Lower Out

128
Q

Radial

A

Upper Out

129
Q

Aspirin is contraindicated to ___________

A

Rheumatoid Arthritis

130
Q

immunosuppressant and anti-inflammatory drug used in patients with RA

A

Steroids

131
Q

could be long term effect of taking steroids for RA

A

-Edema (+aldosterone)

-Hyperglycemia (+ cortisol)

-Infection (↓immune system)

132
Q

anti-inflammatory drug used in patients with RA

A

NSAIDs

133
Q

side effect of NSAIDs

A

GI irritation

134
Q

when to take NSAIDs

A

give with meals

(bc can cause GI irritation)

135
Q

Effect of Aspirin if given to patients with RA

A

-Thrombocytopenia

-Reyes’ Syndrome
(serious condition that causes swelling in the liver and brain)

135
Q

More potent the drug, _______

A

more risky adverse reactions

136
Q

drug for RA that can lessen the progression of RA and can avoid deformity

A

DMARDS (Disease Modifying Anti-Rheumatoid Drugs)

137
Q

Swan’s neck
Boutonniere

A

Rheumatoid Arthritis

137
Q

drug for RA that can lessen the flare ups (sudden swelling)

A

Chloroquine

138
Q

drug for RA that is a COX-2 Inhibitor that is LESSER GI irritant.

Contraindicated to pt with cardiac disease.

A

Celecoxib

138
Q

GOLD STANDARD drug for Rheumatoid Arthritis

A

Methotrexate (antimetabolites)

-have adverse reactions so give last
-kill normal cells
-hepatotoxic

138
Q

signs of Hepatotoxicity

A

Nausea and vomiting (earliest)
RUQ pain
Jaundice with pruritus

139
Q

drug to lessen the side effects of Methotrexate

A

Leucovorin

140
Q

Management for (+) pruritus [bilirubin on skin] due to hepatotoxicity of Methotrexate

A

-Cold compress
-Increase OFI

140
Q

wear and tear of weight bearing joints

A

Osteoarthritis

  • joint disorder, not bone!
140
Q

degeneration of cartilage

-(non-inflammatory)

A

Osteoarthritis

141
Q

Diagnostic test for Osteoarthritis

A

X-Ray:

-narrowing of the joint spaces
-osteophytes formation (new bone growth in compensation)

142
Q

common in athletes, hardworking people (overused)

A

Osteoarthritis

143
Q

localized, asymmetrical

A

Osteoarthritis

144
Q

most common type of arthritis

A

Osteoarthritis

145
Q

[Osteoarthritis]

Distal interphalangeal nodes “DIP”

A

Heberden’s Nodes

H: High

145
Q

grating sound on Osteoarthritis

A

Crepitus

145
Q

[Osteoarthritis]

Proximal interphalangeal nodes “PIP”

A

Bouchard’s Nodes

B:below

146
Q

Worsen with work
-rest until pain subsides

A

Osteoarthritis

147
Q

common in males and hereditary

A

Gouty Arthritis

148
Q

abnormal purine metabolism

A

Gouty Arthritis

149
Q

Asymmetrical, big toe “podagra”

A

Gouty Arthritis

150
Q

When is gouty arthritis more painful?

A

at NIGHT!
-Cold: solidification of crystals

150
Q

confirmatory for Gouty Arthritis

A

Arthrocentesis: presence of joint crystals –> TOPHI

151
Q

[Gouty Arthritis]

_______: food (protein)
Uric acid: blood

A

Purine

151
Q

Management for Gouty Arthritis

A

Decrease Purine Diet!!!

Avoid: organ meat, legumes, sardines, anchovies, alcohol, shellfish (crab, shrimp, lobster, seahorse, starfish, prawn)

152
Q

most painful arthritis

A

Gouty Arthritis

153
Q

acute attack of Gouty Arthritis

A

5-10 days

154
Q

chalk stone (white) deposits on the joints that affect movement

A

Tophi

154
Q

inflammation of big toe

A

Podagra

155
Q

Gout Medications Drug of Choice

A

Allopurinol: Zyloprim

(anti-gout) -dissolves uric acid

156
Q

3 Gout Medications

A
  1. Allopurinol : Zyloprim
    (anti-gout) -dissolves uric acid
  2. Benemid : Probenecid
    (anti-inflamm) - dissolves crystals/tophi
  3. Colchicine : Novocolchine
    (during acute attack)
    (+) diarrhea: Refer
157
Q

for acute attack of Gouty Arthritis

A

Colchicine : Novocolchine
(+) diarrhea: Refer

Contraindicated: Allopurinol

158
Q

Neurovascular Assessment

A

6Ps

Pulselessness
Pallor
Poikilothermia
Pain
Paresthesia
Paralysis

158
Q

nursing intervention for Allopurinol and Benemid

A

increase fluid intake
to prevent renal stones

158
Q

Traction: ______

A

pulling

159
Q

Pain on traction

A

✅Skeletal traction

❌Skin Traction

❌Pin sites

160
Q

When is traction indicated

A

Prior / before surgery

160
Q

Normal capillary refill

A

1-2 seconds

161
Q

Pulse Deficit

A

Apical pulse rate - peripheral pulse rate = pulse deficit

Apical Pulse: 100bpm
Affected periphery: 80 bpm
Pulse Deficit: 20bpm

162
Q

Bad leg (affected) is warmer than good leg (unaffected)

A

Infection

162
Q

Refer all 6Ps of NVA except:

A

Pain

163
Q

Principle of Traction:

Foot of the client should not touch the ____

A

foot of bed

163
Q

distance of crutches

A

6-10 inches

163
Q

distance of cane

A

4-6 inches

164
Q

Elderly; Parkinson’s

A

Walker

165
Q

1 foot affected

A

Crutches

165
Q

2 feet affected

A

Wheelchair

165
Q

Stroke

with “hypertension”
with “hemiparesis / hemiplegia”

A

Cane

166
Q

most stable assistive device

A

walker (4 foot parts)

167
Q

least stable assistive device

A

Cane (only 1 foot part)

167
Q

How to use walker

A

Walker
Walk
Walker
Walk

168
Q

How to use Cane

A

Weakness: Left
Cane: Right

Cane
Lean
Bad leg
Good leg

169
Q

How to Use Crutches Downstairs

A

Crutches
Bad leg
Good leg

170
Q

How to Use Crutches Upstairs

A

Good leg
Crutches + Bad leg

170
Q

duration of drying of Fiberglass cast

A

20-30 minutes

170
Q

duration of drying of Plaster of Paris cast

A

48-72 hours

171
Q

To which patient shall you give sardines?

a. Osteoporosis
b. Gouty Arthritis

A

✅Osteoporosis
❌Gouty Arthritis

172
Q
A
173
Q
A
174
Q

complete opposite of Osteoporosis

A

Rheumatoid Arthritis

RA: systemic, symmetrical
OA: localized, asymmetrical

COMPREHENSIVE PHASE (8 decks)

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