Orthopedics Flashcards
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?
Fracture
What is the one thing we worry about with a fracture
Compartment syndrome
How do we treat fractures
- Immobilize bone ends plus adjacent joints
- Support fracture above and below site
- Move extremity as little as possible
- Use splints
- Cover open fractures with something sterile
What do splints help with
Prevent fat emboli and muscle spasms
When performing a neurovascular check, what are you assessing
Pulse Color Movement Sensation Cap Refill Temp
What are some complications related to Fractures?
- Shock (hypovolemic)
- Fat Embolism
- Compartment syndrome
What kind of fractures do we see shock and fat embolism in
Long bones, femur
Pelvic fractures and crushing injuries
Petechiae or rash over chest conjunctival hemorrage snow storm on cxr young males first 36 hours What are these s/s related to?
Fat Embolism
What is compartment syndrome
It is pressure build up in a limited space,
fluid accumulates in the tissues and impairs it.
What is the main symptom of compartment syndrome
Severe Pain not relieved with pain meds
What are some common areas that compartment syndrome can occur
Forearm and quadricep
What can we do to prevent compartment syndrome
Elevate extremity Soft cast then rigid cast loosen cast to restore circulation -cast cutters to remove cast fasciotomy
How long do you have ice packs on the side for after putting on a plaster and fiberglass cast for?
24 hours, because plaster still wet
What do you use to assess while the casting material is still wet
palm of hands
What should you do for a cast
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
What cast is more common to use
Fiberglass, it is lighter and stronger and provides early weight bearing
What do tractions do
Decrease muscle spasm, reduces immobilizes
Should traction be continuous or intermittent
Continuous
Should the weights be hanging freely and knots secure
yes
What should we maintain for the patient
Good positioning, pulled up in bed centered and good alignmet, exercise non-immobilized and special air filled foam mattress
What are the types of traction
Skin Traction
Skeletal Traction
what are skin tractions used for
short term relieve of muscle spasm and to immobilize until surgery
What assessment is important with skin traction
Skin assessment
What type of traction are
tape, boot, splints, buck
Skin traction
What are skeletal tractions used for
Prolonged traction, months
How are skeletal tractions used
It is applied to the bone with pins and wires
What are Steinman pins, crutchfield, Gardner-well tons, halo vests examples of
Skeletal traction
What should we be monitoring with skeletal traction
Maintain sterile technique
Remove Crusts
and Serous drainage is ok
What type of traction is used frequently pre-op of a hip fracture
Buck’s traction
What things should a nurse be assessing post-op hip surgery
Neuro vascular checks
Monitor drains
Assess firm mattress
Have an over-head trapeze to build upper strength
What kind of position do you have someone post-op a hip surgery
Neutral position, toes to ceiling
Limit flexion, want EXTension of the hip
Abduction
What kind of exercise do we encourage post-op hip surgery
Isometric while in bed
What do we use a trochanter roll for post-op hip surgery
To prevent external rotation and document in nurses notes
When should the patient be weight bearing post-op
After ordered by physician
What should you tell the client to not do after a hip surgery
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
Do we give pain meds to affected hip
no
What are some complications associated with Total hip replacement
Dislocation
Infection
Avascular necrosis
Immobility problems
When someone has a shortening of leg, abnormal rotation and can’t move extremity due to pain what are they showing s/s of
Dislocation
How do we prevent infection for a total hip replacement
Prophylactic antibiotic
and remove foley’s and drains asap
What is avascular necrosis
Death of tissues due to poor circulation
What should we teach clients after hip replacement
to walk/swim and avoid flexion
How does someone avoid flexion of the hip
Avoid low chairs, traveling long distance, sitting more than 30 minutes, lifting heavy objects, excessive bending or twisting, stair climbing
What are some things to remember for a Total Knee Replacement
Use CPM (continious passive motion)
Keep knee in motion and prevent formation of scar tissue
Pain Management
Should the PT set the machine to gradually increase flexion and extension of knees
Yes
Should you hyperextend or hyperflex knees after a total knee replacement
No
What should you be assessing
Neurovascular checks
For an amputation where does it usually occur and why
Done in the more distal point so that the surgeon can preserve the knee and elbow for prostethes
What do you keep at the bedside post-op of an amputation
Turnoquet
Should you be elevating post-amputation
It’s controversial because you could develop contracture, but if you do, elevate bed not use a pillow and only for a short time
How do you prevent contractures of the hip and knee
By extension of the limb, lying flat on the bed
Below the Knee amputation you worry about contractures where?
Hip and Knee
What can you do to prevent contractures on hip and knee
Put patient on stomach
What do you do to decrease phantom pain
Diversional activity/pain management
First diversional, least invasive first
Phantom pain seen more with what kind amputation
Above the knee
When can you expect to see the phantom pain subside
after 3 months
Why is limb shaping important
So you can fit prostehesis
What shape should the stump be shaped at the end
Cone
What is worn under the prosthesis
Limb socks
Why should we strengthen upper body after amputation
So that patient is strong to use crutches or walker
Do you think it is safe to massage a stump and why
Yes, to promote circulation and decrease tenderness
How can one toughen a stump
1) press into soft pillow
2) press into hard pillow
3) Push stump to bed
4) Push stump to chair
With walkers what do you do?
Walk into them
Crutches should be?
1-2 inches below axilla because it could cause brachial nerve damage
Up stairs using crutches
Up with good leg
Down stairs using crutches
Down with bad leg
Canes should be used on what side of the body
Strong side
