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NCLEX > Orthopedics > Flashcards

Orthopedics Flashcards

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1
Q

When someone is in:
Pain/tenderness
Unnatural movement
has a deformity and a shortening of an extremity
has crepitus, swelling and discoloration
These could be s/s of what?

A

Fracture

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2
Q

What is the one thing we worry about with a fracture

A

Compartment syndrome

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3
Q

How do we treat fractures

A
  1. Immobilize bone ends plus adjacent joints
  2. Support fracture above and below site
  3. Move extremity as little as possible
  4. Use splints
  5. Cover open fractures with something sterile
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4
Q

What do splints help with

A

Prevent fat emboli and muscle spasms

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5
Q

When performing a neurovascular check, what are you assessing

A 
Pulse
Color
Movement
Sensation
Cap Refill
Temp
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6
Q

What are some complications related to Fractures?

A
  1. Shock (hypovolemic)
  2. Fat Embolism
  3. Compartment syndrome
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7
Q

What kind of fractures do we see shock and fat embolism in

A

Long bones, femur

Pelvic fractures and crushing injuries

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8
Q 
Petechiae or rash over chest
conjunctival hemorrage
snow storm on cxr
young males 
first 36 hours
What are these s/s related to?
A

Fat Embolism

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9
Q

What is compartment syndrome

A

It is pressure build up in a limited space,

fluid accumulates in the tissues and impairs it.

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10
Q

What is the main symptom of compartment syndrome

A

Severe Pain not relieved with pain meds

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11
Q

What are some common areas that compartment syndrome can occur

A

Forearm and quadricep

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12
Q

What can we do to prevent compartment syndrome

A 
Elevate extremity
Soft cast then rigid cast
loosen cast to restore circulation
-cast cutters to remove cast
fasciotomy
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13
Q

How long do you have ice packs on the side for after putting on a plaster and fiberglass cast for?

A

24 hours, because plaster still wet

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14
Q

What do you use to assess while the casting material is still wet

A

palm of hands

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15
Q

What should you do for a cast

A 
Keep cast uncovered and allow to air dry
do no rest on a hard/sharp surface
circle bleeding and date and time it
neuro vascular checks
cover cast close to groin
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16
Q

What cast is more common to use

A

Fiberglass, it is lighter and stronger and provides early weight bearing

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17
Q

What do tractions do

A

Decrease muscle spasm, reduces immobilizes

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18
Q

Should traction be continuous or intermittent

A

Continuous

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19
Q

Should the weights be hanging freely and knots secure

A

yes

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20
Q

What should we maintain for the patient

A

Good positioning, pulled up in bed centered and good alignmet, exercise non-immobilized and special air filled foam mattress

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21
Q

What are the types of traction

A

Skin Traction

Skeletal Traction

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22
Q

what are skin tractions used for

A

short term relieve of muscle spasm and to immobilize until surgery

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23
Q

What assessment is important with skin traction

A

Skin assessment

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24
Q

What type of traction are

tape, boot, splints, buck

A

Skin traction

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25
Q

What are skeletal tractions used for

A

Prolonged traction, months

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26
Q

How are skeletal tractions used

A

It is applied to the bone with pins and wires

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27
Q

What are Steinman pins, crutchfield, Gardner-well tons, halo vests examples of

A

Skeletal traction

28
Q

What should we be monitoring with skeletal traction

A

Maintain sterile technique
Remove Crusts
and Serous drainage is ok

29
Q

What type of traction is used frequently pre-op of a hip fracture

A

Buck’s traction

30
Q

What things should a nurse be assessing post-op hip surgery

A

Neuro vascular checks
Monitor drains
Assess firm mattress
Have an over-head trapeze to build upper strength

31
Q

What kind of position do you have someone post-op a hip surgery

A

Neutral position, toes to ceiling
Limit flexion, want EXTension of the hip
Abduction

32
Q

What kind of exercise do we encourage post-op hip surgery

A

Isometric while in bed

33
Q

What do we use a trochanter roll for post-op hip surgery

A

To prevent external rotation and document in nurses notes

34
Q

When should the patient be weight bearing post-op

A

After ordered by physician

35
Q

What should you tell the client to not do after a hip surgery

A

Avoid crossing legs, bending over, don’t sleep on operated side until ok by dr.
No stress to hip joints in the first 3-6 months
HYDRATE

36
Q

Do we give pain meds to affected hip

A

no

37
Q

What are some complications associated with Total hip replacement

A

Dislocation
Infection
Avascular necrosis
Immobility problems

38
Q

When someone has a shortening of leg, abnormal rotation and can’t move extremity due to pain what are they showing s/s of

A

Dislocation

39
Q

How do we prevent infection for a total hip replacement

A

Prophylactic antibiotic

and remove foley’s and drains asap

40
Q

What is avascular necrosis

A

Death of tissues due to poor circulation

41
Q

What should we teach clients after hip replacement

A

to walk/swim and avoid flexion

42
Q

How does someone avoid flexion of the hip

A

Avoid low chairs, traveling long distance, sitting more than 30 minutes, lifting heavy objects, excessive bending or twisting, stair climbing

43
Q

What are some things to remember for a Total Knee Replacement

A

Use CPM (continious passive motion)
Keep knee in motion and prevent formation of scar tissue
Pain Management

44
Q

Should the PT set the machine to gradually increase flexion and extension of knees

A

Yes

45
Q

Should you hyperextend or hyperflex knees after a total knee replacement

A

No

46
Q

What should you be assessing

A

Neurovascular checks

47
Q

For an amputation where does it usually occur and why

A

Done in the more distal point so that the surgeon can preserve the knee and elbow for prostethes

48
Q

What do you keep at the bedside post-op of an amputation

A

Turnoquet

49
Q

Should you be elevating post-amputation

A

It’s controversial because you could develop contracture, but if you do, elevate bed not use a pillow and only for a short time

50
Q

How do you prevent contractures of the hip and knee

A

By extension of the limb, lying flat on the bed

51
Q

Below the Knee amputation you worry about contractures where?

A

Hip and Knee

52
Q

What can you do to prevent contractures on hip and knee

A

Put patient on stomach

53
Q

What do you do to decrease phantom pain

A

Diversional activity/pain management

First diversional, least invasive first

54
Q

Phantom pain seen more with what kind amputation

A

Above the knee

55
Q

When can you expect to see the phantom pain subside

A

after 3 months

56
Q

Why is limb shaping important

A

So you can fit prostehesis

57
Q

What shape should the stump be shaped at the end

A

Cone

58
Q

What is worn under the prosthesis

A

Limb socks

59
Q

Why should we strengthen upper body after amputation

A

So that patient is strong to use crutches or walker

60
Q

Do you think it is safe to massage a stump and why

A

Yes, to promote circulation and decrease tenderness

61
Q

How can one toughen a stump

A

1) press into soft pillow
2) press into hard pillow
3) Push stump to bed
4) Push stump to chair

62
Q

With walkers what do you do?

A

Walk into them

63
Q

Crutches should be?

A

1-2 inches below axilla because it could cause brachial nerve damage

64
Q

Up stairs using crutches

A

Up with good leg

65
Q

Down stairs using crutches

A

Down with bad leg

66
Q

Canes should be used on what side of the body

A

Strong side

NCLEX (21 decks)

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