Orthopedics

Question 1

Fractures s/s

Answer 1

Pain / tenderness 
unnatureal movement
deformity
shortening of extremity due to muscle spasms 
crepitus
swelling
discoloration 

*worry compartment

Question 2

Txt for fractures

Answer 2

• *immobilize bone and adjacent
• support above and below
• move as little ass possible

splints decrease fat emboli and muscle spasms
For open fractures cover with sterile
Assess neurovas

Question 3

What is neurovas

Answer 3

pulse, color, movement, sensation, cap refill temp

Question 4

what are complications of fractures

Answer 4

hypovo shock specifically w/
pelvic fractures
crushing injuries
multiple long bone

Question 5

Fat emboli occurs with

Answer 5

Seen with same fractures
pelvic
crushing injur
long bone

young males
first 36 hrs after injury

Question 6

S/S of fat emboli

Answer 6

depending where it is but unusual
petchiae on chest
conjuctival hemo
snowball cxr

Question 7

Compartment symdrome

Answer 7

increased pressure in a small space

fluid accumulates in tissue and impairs perfusion. muscle becomes swollen and does not relieve with pain meds, can lead to nerve damage and amputation

Common areas are arms and quads

Question 8

Txt of compartment

Answer 8

losen the cast - called bivalving
becareful choosing remove cast cause its like the last resort use saw cutters that dont touch skin explain to client it just vibrates.

Fasciotomy cuts down tissue to relieve pressure and restore circulation

Question 9

Plaster cast care

Answer 9

Ice packs for first 24hrs ON THE SIDE, prevent indents use pals for first 24-72 hrs. no fingers!
Let it be uncovered, air dry, soft surface, mark bleeding circle time and site, cover cast close to groin with plastic and neurovas checks

Question 10

What to do if plaster care client reports of pain

Answer 10

Neurocheck, elevate, cold pack pain meds if unrelieved think compartment.

Question 11

Fiberglass cast

Answer 11

Dries within 30 minutes, lightweight, waterproof and stronger than plaster cast, better on xray, can allow weight bearing but its difficult to contour and so used only with small fractures

Question 12

Traction

Answer 12

Used to reduce and immobolize fracture, reduce spasms, pain, realign bone and prevent deformity

Weights hang freely not on floor , exercised nonimbolized joints, ropes should be moving freely and knots should be secure, special mattress, prevent foot drop use foot boot

Question 13

Skeletal traction should be

Answer 13

continous why?

Question 14

Foot drops are problems with clients who are

Answer 14

immobolize for a long time such as ortho spinal clients

Question 15

Skin traction

Answer 15

Use to relieve muscle spasms up until surgery, some type of boot or splint in which weight pulls against it. a common type is bucks and requires skin assessment 3x a day

Question 16

Skeletal Traction

Answer 16

Pins and wires are applied and utilized to prolong traction. must monitor every 8hrs and care begins 48-72 hrs after insertion. requires sterile technique. clear fluid may drain and it is okay

Question 17

Post op care for total Hip replacement

Answer 17

Buck traction to immbolize fracture

Question 18

Clients with orthopedic joint problems require what?

Answer 18

Firm matress

Question 19

Nursing consideration Post op Total Hip

Answer 19

When I assess the patient the patient should be lying on a FIRM mattress. Ill start first with checking my neurochecks, then moving onto their position. They should be neutral (toes up) EXTENSION not FLEXSION, and abduction. and a trochanter roll under to prevent the external document.

When they exercise they should have atrapeze to build upper core strength, isometric exercises. NWB.

Question 20

What are your complications for hip/traction?

Answer 20

Dislocation which makes circulatory and nerve damage.

s/s shortened leg, abnormal rotation, cant move , and pain

Infection
Give antbiotics and remove indwelling catheters anything foreign in the body act as a portal of infection

avascular necrosis - lack of circulation
immobility problems

Question 21

Client education for Rehab in total hip replacement

Answer 21

best exercise is walking, swimming, rocking

avoid flexing anything bending the knee too much

Question 22

Amputations

Answer 22

Performed at the most distal point, and usually perserves knee or elbow.

Question 23

Post op care amputations

Answer 23

Tourniquet at beside just incase of hemorrhage, prevent contractures how? patient should lie flat, and position should be prone

Question 24

How to deal with phantom pain with amputees?

Answer 24

Always use diversional activities, then pain meds, usually subsides 3 months after. This is seen more with above knee amputations

Question 25

Rehab for amputees

Answer 25

Limb shaping?
Cone at the end to fit prosthesis
Why wear a limb sock - to allow pressure to prevent hemorrhage, and then later to shape
Upper strength required
massage the stump to promote circulation and decrease tenderness

Question 26

How do you toughen a stump?

Answer 26

Soft pillow
firm pillow
bed
chair

Question 27

Walkers

Answer 27

You walk into

Question 28

Crutches

Answer 28

1-2 below axilla to prevent brachial nerve injury
rest body weight on hands
lead with good down with bad