Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/116

Click to flip

116 Cards in this Set

  • Front
  • Back
The reconstruction or placement of a joint?

a)OSEOTOMY
b)ARTHROPLASTY
c)SYNOVECTOMY
d)SUBLAXATION
ARTHROPLASTY
Inflammation of the bursa resulting from repeated or excessive trauma or friction, gout, rheumatoid arthritis, or infection/ AMB warmth, pain, swelling, and limited ROM in the affected part is?

a) SUBLAXATION
b) COMPARTMENT SYNDROME
c) BURSITIS
d) CARPAL TUNNEL SYNDROME
BURSITIS
A condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within the space (very scary)/ causes capillary perfusion to be reduced below a level necessary for tissue viability and is classified as acute, chronic/exertional, or crush?

a) SUBLAXATION
b) COMPARTMENT SYNDROME
c) FAT EMBOLISM SYNDROME
d) CARPAL TUNNEL SYNDROME
COMPARTMENT SYNDROME
The removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint is?

a)SUBLAXATION
b)ARTHROPLASTY
c)SYNOVECTOMY
d)DEBRIDEMENT
DEBRIDEMENT
The presence of fat globules in tissue and organs after a traumatic skeletal injury & a a contributory factor in many deaths is associated with? fractures /most common bones: long bones, ribs, tibia, and pelvis:

a) SUBLAXATION
b) COMPARTMENT SYNDROME
c) FAT EMBOLISM SYNDROME
d) CARPAL TUNNEL SYNDROME
FAT EMBOLISM SYNDROME
The removing or adding a wedge or slice of bone to change its alignment and shift weight bearing, thereby correcting deformity and relieving pain?

a)OSEOTOMY
b)ARTHROPLASTY
c)SYNOVECTOMY
d)SUBLAXATION
OSEOTOMY
A cumulative trauma disorder resulting from prolonged, forceful, or awkward movements is?

a) SUBLAXATION
b) COMPARTMENT SYNDROME
c) REPETITIVE STRAIN INJURY
d) CARPAL TUNNEL SYNDROME
REPETITIVE STRAIN INJURY
A partial or incomplete displacement of the joint surface is?

a)CARPAL TUNNEL SYNDROME
b)COMPARTMENT SYNDROME
c)REPETITIVE STRAIN INJURY
d)SUBLAXATION
SUBLAXATION
The removal of synovial membrane; is used as a prophylactic measure and as a palliative treatment of rheumatoid arthritis RA?

a)OSEOTOMY
b)ARTHROPLASTY
c)SYNOVECTOMY
d)SUBLAXATION
SYNOVECTOMY
The application of a pulling force to an injured or diseased part of the body or an extremity while countertraction pulls in the opposite direction:

a)TRACTION
b)ARTHROPLASTY
c)SYNOVECTOMY
d)SUBLAXATION
TRACTION
A condition caused by compression of the median nerve beneath the transverse carpal ligament within the narrow confines of the carpal tunnel located in the wrist/ most common compression neuropathy:

a)SUBLAXATION
b)CARPAL TUNNEL SYNDROME
c)BURSITIS
d)COMPARTMENT SYNDROME
CARPAL TUNNEL SYNDROME
A condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within the space (very scary)/ causes capillary perfusion to be reduced below a level necessary for tissue viability and is classified as acute, chronic/exertional, or crush:

a)SUBLAXATION
b)CARPAL TUNNEL SYNDROME
c)BURSITIS
d)COMPARTMENT SYNDROME
COMPARTMENT SYNDROME
The removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint:

a)SUBLAXATION
b)ARTHROPLASTY
c)SYNOVECTOMY
d)DEBRIDEMENT
DEBRIDEMENT
Characterized by the presence of fat globules in tissue and organs after a traumatic skeletal injury/ is a contributory factor in many deaths associated with fractures /most common bones: long bones, ribs, tibia, and pelvis:

a)FAT EMBOLISM SYNDROME
b)CARPAL TUNNEL SYNDROME
c)BURSITIS
d)COMPARTMENT SYNDROME
FAT EMBOLISM SYNDROME
Removing or adding a wedge or slice of bone to change its alignment and shift weight bearing, thereby correcting deformity and relieving pain:

a)SUBLAXATION
b)ARTHROPLASTY
c)SYNOVECTOMY
d)OSEOTOMY
OSEOTOMY
A cumulative trauma disorder resulting from prolonged, forceful, or awkward movements:


a)REPETITIVE STRAIN INJURY
b)CARPAL TUNNEL SYNDROME
c)BURSITIS
d)COMPARTMENT SYNDROME
REPETITIVE STRAIN INJURY
A partial or incomplete displacement of the joint surface:

a)SUBLAXATION
b)CARPAL TUNNEL SYNDROME
c)BURSITIS
d)COMPARTMENT SYNDROME
SUBLAXATION
Used as a prophylactic measure and as a palliative treatment of rheumatoid arthritis (removal of synovial membrane):

a)SUBLAXATION
b)ARTHROPLASTY
c)SYNOVECTOMY
d)OSEOTOMY
SYNOVECTOMY
The application of a pulling force to an injured or diseased part of the body or an extremity while countertraction pulls in the opposite direction:

a)SUBLAXATION
b)TRACTION
c)SYNOVECTOMY
d)OSEOTOMY
TRACTION
Complete or incomplete tear in supporting ligaments surrounding a joint:

a)strain
b)subluxation
c)sprain


 Sharp sudden wrenching or twisting motion
– Turning your ankle
 Joint stretched beyond capacity
– Tearing of ligaments, muscles, capsule, or synovium
 Worse than a strain
Sprain
Pt's chief complaint is "I twisted my ankle" & the RN observes pain w/ movement, swelling, ecchymosis & warmth to the touch.

a)strain
b)subluxation
c)sprain
c)sprain
A sharp sudden wrenching or twisting motion such as turning the ankle causing a joint to stretch beyond capacity resulting in torn ligaments, muscles, capsule, or synovium.

a)strain
b)subluxation
c)sprain
sprain

WORSE THAN A STRAIN !
A sprain is a torn ____ that causes bleeding. A Hematoma forms & ____ exudate developes in addition to granulation tissue & collagen forms. Swelling or stretching of ___ or ___ occurs and chronic ___ instability results.
ligament
Inflammatory
nerves or vessels
joint
Assessment of swelling, pain, ecchymosis, limited joint movement, warmth, & snapping sound at injury indicates a:

a)strain
b)subluxation
c)sprain
sprain
Tx for a sprain is:

R - ___

I - ___

C - ___

E - ___

NSAIDS & after 24-48 hours use heat for 20-30 min & cool down period. Splint or cast.
RICE:

Rest - Limited movement, & rest extremity

Ice - First 24-48 hours for vasoconstriction, reduce nerve impulses, reduce muscle spasms, edema, & inflammation (20-30 minute on & 10-15 min off)

Compression - limit edema using elastic wrap for 30 min & removed for 15 min

Elevation - above level of heart

NSAIDS & after 24-48 hours use heat for 20-30 min & cool down period. Splint or cast.
A sprain is an injury to:

a) ligamentous structures surrounding a joint caused by wrenching or twisting

b) excessive stretching of a muscle, often involving the tendon
a) ligamentous structures surrounding a joint caused by wrenching or twisting
The difference iin a sprain & a strain:

a) a sprain can usually be identified w/limited joint movement

b) a strain can usually be identified w/limited joint movement
a) a sprain can usually be identified w/limited joint movement
A sprain is worse than a strain?

true or false?
true
Rice tx includes ice the 1st __-__ hours & 20-30 min on / 10-15 min off & after __-__ hours heat 20-30 min on & cool down period.

Compression w/elastic wrap __ min on & ___ min off
24-48 hours
24-48 hours

Ice:
- vasoconstrictor
- reduces nerve impulses
- reduces muscle spasms
- reduces edema
- reduces inflammation
Heat:
- improves circulation
- stimulates macrophage

30 min on/15 min off
Teaching care of sprains & strains includes:

How to ___ ice/heat therapy, how to apply ___ bandages, using crutches, & ___ information. It is important to explain ___ of ice & heat to Pt in addition to putting pressure on ___ not ___ if using crutches.
apply
compression
medication

alternating
hands not arm pits
The most common sites for a sprain is in the ___ & ___. The affected part is usually ___ to rule out fracture or widening of a joint structure.
ankle
wrist

x-ray
Pt asks how long it will take for a minor strain/sprain to heal:

a) full fxn w/in 3-7 days
b) full fxn w/in 1-2 wks
c) full fxn w/in 3-4 wks
d) full fxn w/in 3-6 wks
full fxn w/in 3-6 wks
Health promotion stresses the importance of ___ exercises before vigorous activity to reduce __ & __.
warm-up

sprains & strains
Pt asks what "subluxation" means. You tell him:

a) A subluxation is severe injury of ligamentous structures surrounding a joint resulting in a complete displacement of the articular surfaces of a joint

b) A subluxation is severe injury of ligamentous structures surrounding a joint resulting in a partial or incomplete displacement of the joint surface
b) A subluxation is severe injury of ligamentous structures surrounding a joint resulting in a partial or incomplete displacement of the joint surface
A dislocation is a ___ displacement or ___ of the articular surfaces of a joint.
complete

separation
Dislocations result from overwhelming forces pushing the bone from the joint & articulating surfaces totally lose ___. The most common sites are in the upper extremities including the thumb, elbow & ___. The hip is is vulnerable as a result of severe trauma. The ___ may dislocate b/c of instability of tendons, ligaments, & muscles surrounding the knee or a severe twisting blow.
contact
shoulder

patella
The most obvious manifestation of a dislocation is a ___ deformity of the affected extremity. In addition to pain, swelling, tenderness, Pt's will have limited fxn, may experience spasms, numbness, ecchymosis. Area will become ___ to the touch, ___ pulse & decreased ___ ___.
a visable deformity

cool
decreased
cap refill
Dislocations & subluxations are serious injuries requiring emergency care b/c of severe ____ compromise & damage to ____ tissue. Pallor, pain, pulslessness, paralysis, & parasthesia are all indications for ___ ___.
vascular
neurovascular

IMMEDIATE ATTENTION
A disclocation is an orthopedic ___ b/c the longer a joint remains unreduced the greater the possibility of avscular ____. The 1st GOAL of tx is to realign the joint. INITIAL tx is ensure ___, ___, ___. Assess ___ status of limb, elevate, apply compression bandage, apply ice, immobilize extremity in position found, anticipate ___, administer analgesia & ___ prophylaxis if skin is broken.
emergency
necrosis

airway, breathing & circulation

neurovascular

x-rays
tetanus
Conduct neurovascular assessments of affected extremity for a dislocation at admission, PRN, & immediately ___.

Conduct NV assessments __x__ & q4h x 48-72 hrs & increase frequency if NV status ___.

Indicate which extremity is to be evaluated & compare to the unaffected extremity.

RUE = ___ ___ extremity
LUE = ___ ___ extremity
RLE = ___ ___ extremity
LLE = ___ ___ extremity

Note:
COLOR - pink, pale, cyanotic, mottled

TEMP - warm, cool, cold

CAP REFILL - rapid, sluggish, prolonged, > < 3 seconds

EDEMA - absent, mild, moderate, pitting (how much)(edema puts pressure on the area)

PULSE - strong, weak, not palpable, doppler
Specify pulse tested:
DP- dorsalis pedis
PT- posterior tibial
Femoral, Popliteal
Radial, Ulnar, Brachial
Auxillary

SENSATION - Numbness, motion, tingling, Moves freely, painful, minimal, unable

PAIN - Scale, description (remember diabetics have decreased sensations)
post OP

q2h x 24h
changes

RUE = right upper extremity
LUE = left upper extremity
RLE = right lower extremity
LLE = left lower extremity
Carpal Tunnel Syndrome is caused when trauma/edema, tumors, ganglion, & excessive use of wrists ____ the medial nerve under the carpal ligament in the wrist. Manifestations of Carpal Tunnel is weakness, pain, tingling, & ____ night & day. Pt's experience ___ in thumb, forefingers, & middle finger.

Non Invasive treatment is use of a ___ to maintain a neutral position for 1-2 weeks. Gentle ROM, NSAID’s, Hydrocortisone & lidocaine injection. Occupation change may be necessary.
compresses
numbness
paresthesia

splint
When the Pt drop her wrist to a flex position for 60 seconds she experiences carpal tunnel symptoms. This is called ____ sign. When you tap over the medial nerve she experiences pain shooting up her arm. This is known as ___ sign.
Phalen’s sign (phalen flex)

Tinels Sign (shooting tinel)
The meniscus is the ____ in the knee & other joints & injuries are closely assoc. w/ligament sprains experienced by athletes. Occupations requiring ___ or ___ positions may be at a higher risk for meniscus injuries. Injuries do not usually cause chronic edema b/c cartilage is ____ & ____ but a torn meniscus will cause local tenderness or pain. Pain is elicited by abduction or adduction of leg at the knee & Pt may feel like their knee is unstable & may report a "click, lock, give-a-way." Quadraceps ___ is evidence the injury has been present for some time. Diagnosis can be made with a ___, ___, ___. Surgery is a partial or total meniesectomy by ___.
fibrocartilage

squatting or kneeling
avascular & aneural
atrophy
arthrogram, arthroscopy, MRI

arthroscopy
Bursae are ___ ___ lined w/synovial membrane & fluid located at sites of ___ such as between tendons & bones & near joints. Bursitis is inflammation of bursa caused by repeated or excessive trauma, friction, gout, rheumatoid arthritis, or infxn. Repeated kneeling, jogging, worn out shoes, & prolonged sitting w/legs ___. (tennis elbow, housemaid’s knees, shoulders & hips).

Assessment is ___ ___, irritation, & inflammation.

Tx: rest &/or immobilization, sling, splint, or cast, & cold/heat applications.

Drugs: lidocaine injections in bursa sac,___, & NSAID’s.

Life style change is often necessary.
closed sacs
friction
crossed
Limited movement

corticosteroid
Fractures are cracks or breaks in bone. S&S are pain, point tenderness, muscle spasms, numbness, tingling, & paralysis. Fractures are marked by shape, loss of fxn, edema, ecchymosis, crepitus, & severe muscle rigidity.

Types of fractures include:

___ from strong pulling
___ 2+ fragments
___ overriding
___ driven into
___ disease, sudden
___ jogging, etc
___ obique
___ spiraled
___ transverse
___ to articular surface
___ longitudinal
Avusion
Communited
Displaced
Impacted
Pathologic
Stress
Oblique
Spiral
transverse
Interarticular
longitudinal
Name 4 children’s fractures:
Bends (boxer’s FX)
Buckle (tores fx)
Greenstick
complete
An open fracture is also called a ___ ___ & is thru the skin exposed to the enviroment. A closed fracture is also called a ___ ___ & does not extend into the environment.
compound fracture

simple fracture
In the healing process of a fracture a blood clot forms & surrounds damaged structures providing primitive cells for bone healing in first 1-3 days. This is a:

a) Granulation
b) Consolidation
c) HematomaI formation
d) Callus formation
e) Remolding
Hematoma formation
In the healing process of a fracture the formation tissue containing blood vessels, fibroclasts, osteoblasts, & granular appearance begins in 3 days - 2 weeks. This is:

a) Granulation
b) Consolidation
c) Hematoma formation
d) Callus formation
e) Remolding
GranulationII (3days - 2wks)
In healing process of a fracture the maturation of granulation tissue into scaffolding to mineralized bone matrix & collagen occuring in 2 - 6 weeks. This process is:

a) Granulation
b) Consolidation
c) Hematoma formation
d) Callus formation
e) Remolding
CallusIII formation
In healing process of a fracture osteoblasts & firoblasts continue to multiply, bridging gaps in bone, ossification, occurring in 3 weeks – 6 months. This is:

a) Granulation
b) Consolidation
c) Hematoma formation
d) Callus formation
e) Remolding
ConsolidationIV 3wks-6mo's
In the healing process of a fracture differential absorption & deposition of bone along line of stress & the re-establishment of the medullar canal occurs resulting in the return of bone to pre-fracture state. This final stage is:

a) Granulation
b) Consolidation
c) Hematoma formation
d) Callus formation
e) Remolding
RemoldingV
Healing Times for fractures:

Neonatal Period: __-__ wks

Early Childhood: __ wks

Later Childhood: __-__ wks

Adolescence: __-__ weeks
N - 2-4 weeks
E - 4 wks
L - 6-8 weeks
A - 8-12

I will probably remember this as "Nela 2,4,6,8"
Tx for a fracture is:

___ immediately

Fracture reduction:

Open-
Correct w/surgical procedure

Closed-
Manual realignment to original position

Traction

Realignment
Skin or skeletal
Splint
Total Joint Replacement is the surgical removal of deformed or diseased joint surface & replaced w/a smooth artificial surface using ____ or ____. This procedure is done for knee, hip, shoulder, ankle, & wrist & lasts aprx. __ years. The purpose is ___ relief, increased ____, & improved motor function.
metal or plastic
20
pain
ROM
Total Joint Replacement is the surgical removal of deformed or diseased joint surface & replacement w/a smooth artificial surface using ___ or ___. This procedure is used for knee, hip, shoulder, ankle, wrist, & last apprx years. The purpose for this procedure is (name 3) ___, ___, ___.
metal or plastic
20

– Pain relief
– Increased ROM
– Improved motor fxn
What age group is at the greatest risk for a hip fracture:

a) 14-18 yrs
b) 25-40 yrs
c) 45-55 yrs
d) 65 +
65 +
Predisposing factors for the occurrence of hip fractures are diminished ___, slow ___. muscle ____, diminished bone strength as a result of ____.
equilibrium
reflexes
atrophy
osteoporosis
Hip fractures are more common in women due to osteoporosis than in men.

true or false
true
30 to 50% of Pt's who experience a hip fracture never regain full motion & ___% die within the 1st year.

a) 10-15%
b) 14-36%
c) 35-40%
d) 50%
14-36%
A hip fracture refers to a fracture of the proximal third of the ___. Fractures that occur within the hip joint capsule are called ____ fractures. A capital hip fracture is of the ___ of the femur, a subcapital is just below the head, a transcervical is of the ___ of the femur. These are often associated with osteoporosis & minor trauma. An extracapsular fracture is caused by a ___ or severe direct trauma & located ___ the joint capsule. Extracapsular fractures are called intertrochanteric or subtrochanteric. Intratrochantertic fractures are between the greater & ___ trochanter. A subtrochanteric occurs ____ the lesser trochanter.
femur
intracapsular
head
neck
fall
outside
lesser
below
Assessment of Hip Fractures include external ___, shortening of the affected ___, pain & tenderness at ___ site, ____ of surrounding tissue, inability to move injured leg when lying ___. Tx is surgical ___ & internal ___.
rotation
extremity
fracture
discoloration
supine
repair
fixation
Causes for a total hip or knee replacement are INJURY such as a ____ or CHRONIC ILLNESS illness such as ___ ___ or necrosis due to long term use of ____ steroids &/or ____ which reduces blood supply to the bone, & WEAR & TEAR from osteoarthritis.
fracture
rheumatoid arthritis
alcohol
Benefits of joint replacement
are decreased ____, increased ____, & increased ____.
pain
strength
mobility
Patient Preparation for a Total Hip Joint or Knee Replacement would include advising patient to do what?

Name at least 4 things.
Stock up on food

Store food on shelves at waist or on a countertop or table at waist height for easy access

Prepare sleeping & bathroom for use

Place the bed on the first floor if not already there

Bedside commode if bathroom is located on the second floor

Pick up clutter

Obtain special equipment

Elevated toilet seat

Shower seat

Install handrails and grab bar

Long handled sponge

Sock
Name 3 Nursing "PRE-OP" interventions for a joint replacement.
PAIN MANAGEMENT:
– Pain scale
– Positioning
– Traction
Bucks/Russell: traction that aids in decreasing pain R/T muscle spasms

PRE-OP TEACHING:
– Patient contract
– Foley
– Skin care
– Mobility: trapeze, side rails, non-weight bearing for 3-5 months (hip)

CPM:
- Continuous passive motion machine
- Passive motion to gradually increase until 90 degrees is met (knee)
Name 5 Nursing "POST-OP" interventions for a joint replacement:
VS, I & O

Respiratory:
TCDB, IS

Infection Assessment:
Fever, drainage, redness, pain, elevated WBC

Thrombus/emboli precautions:
TED stockings-
On early AM, less edema
Off every night
Anticoagulants

Pain control

Assess incision

Drainage/bleeding

Assess circulation:
Toes, movement color temp, edema, tingling, cap refill

Abductor pillow or splint(Hip)

Mobility:
Use opposite leg to pivot
PRE-OP interventions for Joint Replacement include positioning, pain ___ using a pain ___ & Bucks or Russel ____ to decreases pain R/T ____ ____. Teaching is also important & a patient ____ is required. Teaching also includes discussion of Foley & skin ___, in addition to use of trapeze & side ____ and non weight bearing activity for ___-___ months for patients having a hip joint replacement. CPM, which is a continuous ___ ___, is passive motion to gradually increase to ___ degrees for total ___ replacements is also taught. ____ chairs are also recommended to patients for use after surgery.
– Foley
– Skin care
– Mobility
 Trapeze, side rails, non-weight bearing for 3-5 months (hip)
– CPM
 Continuous passive motion machine
 Passive motion to gradually increase until 90 degrees is met
– Knee
management
scale
traction
muscle spasms
contract
care
rails
3-5 months
motion machine
90 degrees
knee
rocking
POST-OP nursing interventions are VS, I & O's, & respiratory ___, ___, ___, & ___ (TCDB) & IS (incentive spirometry). Assessing for ____ includes monitoring ___, drainage, ____, pain, & elevated ___. Precautions for Thrombus/emboli are taken w/anticoagulants, & ___ stockings which are to be put on in the early AM when there is less edema & off every ___. The nurse requires a ___ ___ of Ted stockings on & off. Additional interventions include pain ___ control, assessing the ___ for drainage & ____. Assessing circulation by toes, movement color temp, edema, tingling, cap refill & Abductor Pillow (wide end up) for hip or splint. Patient must learn to use the ____ leg to pivot.
turn, cough, deep breath
infection
Fever
redness
WBC
TED
night
return demonstration
incision
bleeding
unaffected
Discharge teaching for a Hip Fracture includes do not ___ legs, do not stand w/toes ___ ___, do not squat or sit on ___ toilet stool or ___. Don’t ___ way over or get up ___ forward. Do not lay on ______ side without legs wide apart or cross legs to ___ ___ ___. Patient is NOT to break the ___ % angle & should use devices such as long handled grasper to reach down. Pt's should get assistance with dressing, socks & ___.
cross
turned in
low
chair
lean
bending
un-operated
put shoes on
90
pants
Home safety for Pt's w/joint replacement include instructions on how to ___ down, put on socks & shoes w/___, going up & down ___, & getting into a ___.
sit
help
stairs
car
Pt's with joint replacement should be taught to sit down by ___ up to the edge of the chair until legs ___ the chair, & lower self into seat keeping the operated leg out ___.
backing
touch
front
Patients w/ joint replacement should learn to put on socks & shoes w/___ & use a sock assist or ___ arm grasping device.
– Slip on shoes
help
long
Pt's who have undergone joint replacement should learn to go up stairs by stepping up first with ___ leg & then bring up ___ leg & go down the stairs starting with the ___ leg
good
operated
operated

"UP w/the GOOD - DOWN w/the BAD"
Pt's who have a joint replacement should learn how to get into a car by facing the ___ & backing up until care seat touches your legs
& then ___ body into the car seat.
outside
pivot
Discharge Teaching for Total Knee Replacement includes Do not twist your ___. Turn your body as a whole unit. A New prosthesis allows you to turn your knee. Do not perform high ___ activities such as running, jumping, race walking, or playing basketball. DO START exercises for increased muscle ___ such as Quad sets, & inprove joint movement w/____ knee bends.
knee
impact
strength
sitting
Building muscle strength post knee surgery includes doing Quad Sets. This is sitting against the ___ & placing the leg with the ___ joint straight out in front & then ____ the front leg muscles while pulling the ___ toward your thigh. Then press the back of the leg toward the ___ & hold for a count of ___ . Repeat as directed.
HOB
new
tighten
kneecap
ground
5
Improved Joint Movement can be aquired by sitting in a chair with a towel under the ___ knee joint, ____ your legs as much as you can for the count of ___ & then ___ your leg back as far as you can & ___ for a count of 5. Repeat.
new
straighten
5
bend
hold
Amputation is the removal of an extremity or part of an extremity due to CIRCULATORY problems such as perepheral ____ disease(PVD, diabetes ___ (DM), & ____ heart disease (ASHD), TRAUMATIC INJURY, MALIGNANT TUMORS, or an UNCONTROLLED ____ (gangrene).
vascular
mellitus
atherosclerotic
INFECTION
Gas Gangrene is Gram ___ Clostridium perfringens or tetanus. Also known at ___ gangrene. It can occurr due to contaminated ___ fractures &/or poor union & ___. Assessment is from cellulites engorged w/gas ___, foul smelling watery exudate, ___ pulse & leads to ___ shock w/ redness, swelling, warmth, ____ drainage, & low grade temperature elevation. Tx is antibiotics & amputation.
positive
open
callus
bubbles
decreased
septic
purulent
Types of amputations are ___ & ___. Amutations leaving flaps of muscle or tissue that creates an anterior flap that pulls over & covers the bone stump are called ___. Amputatations called Guillotine are ___ & b/c soft tissue & bone are severed at the same level & healing occurs as secondary intention due to the prescence of ___.
Open
Closed
closed
open
infection
Phantom Limb Sensation is when the Pt feels the amputated part is still ___ with pain, tingling, numbness, itching, & temperature change. This sensation may last several ___ to ___. Pt's may describe aching, knifelike, jabbing, throbbing, tearing, burning pain in amputated part. Relief is ___ of residual limb & ____ activities.
present
months to years
exercise
diversion
Post OP Care for amputation's are assess for ___ & infection, & drainage in the ___ & ___ of dressing as well as ___ types. Carefull attention to ___ technique is impt to reduce the potential for ____. Types of dressings are a soft bandage, rigid dressing (casts), or Air splint. Dressings are very important because they help to reduce edema & ___ ___ ___. Dressings may be applied immediately in surgery or delayed. Delayed are the best choice for Pt's w/amputations ___ the knee or ___ the elbow (usually due to infection). The nurse will keep limb elevated for the 1st ___ hours. Pillows under the stump for extended periods can cause ____. Prevent external rotation & abduction contractures with correct ___ in bed, & using rolled towels or sand bags when ___. If Pt has contractures they should be placed on abdomen for 30 minutes ___hours which ____ out the stump & avoid sitting in chairs with hip ___.
hemorrhage
bottom and back
dressing
sterile
infection
shape the stump
above
below
24
contractures
alignment
sitting
q 4-6
straigtens
flexed
ROM & prevention of edema is very important. ___ ___ helps shrink & shape the limb. Cover all skin when ____. Remove & reapply wrap ____ hours. Make sure wrap is ___ & non constricting & should be worn at all times except during PT & ___.
elastic wrap
wrapping
Q 4-8
smooth
bathing
Patient Teaching includes inspection daily for irritation, redness, abrasion & areas prone to ___. Discontinue use of prosthesis if irritation develops & have checked before ___. Wash limb each night w/ warm water & ____ soap, rinse & dry gently, air for ___ min. Pt's should not use any lotions, alcohol, powders, or oils unless ___. Wear only a residual limb ___ that is in good condition & supplied by the prosthetist & change ___. Launder in mild soap, squeeze & lay flat to dry. Use prescribed pain management techniques & perform ___ to ALL joints daily. Perform general strengthening exercises including ___ extremities daily. DO NOT ____ the limb on a pillow & lay ___ w/hip extension for 30 min ___ times daily.
pressure
re-use
bacteriostatic
20
prescribed
sock
daily
ROM
upper
elevate
prone
3-4
Movement of a prosthetic device below the knee takes ___% more energy & ___% more if prosthetic is above the knee.
40%
60%
Compartment Syndrome is pressure within a limited anatomic space such as in a cast on the forearm & and lower leg. Compartment syndrome depresses circulation, decreases viability & function of tissue within the space. Tissue damage can occur within 30 minutes & > 4 hours causes irreversible damage. Assessment includes the 5 P’s. Name them:
1-___
2-___
3-___
4-___
5-___
PAIN
severe or increased

PALLOR

PARATHESIA
numb/tingle/decreased sensatn

PARALYSIS
Decrease or loss of movement & strength

PULSLELESSNESS
Loss of distal pulse
Evaluate Compartment pressure monitor
Nursing Management for compartment syndrome is to relieve ___ & prevention.
Relieving pressure includes cutting the cast but NOT remove it. Prevention includes inspecting the dressing & ___ frequently, elevation, ice packs, ___ edges of cast, loosening the dressing, monitoring _____ pressure
(> 30 mm HG)& fasciotomy.
pressure
cast
petal
intracompartment
Name 5 complications of Compartment syndrome:

1-
2-
3-
4-
5-
Infection
Amputation
Contractures
Loss of function
Renal failure ( due to release of myoglobin in the blood from the muscle from injury). Myoglobin molecule too large for effective filtration and excretion by kidney- blocks.
Fat Embolism is when fat globules are released from the ___ of long ___ fractures or multiple trauma into the blood stream. This causes ___ to clump & form fat emboli or obstructions of pulmonary & vascular beds. Organs effected are lungs, vessels, brain, heart, kidneys, tissues & other organs. Fat embolism causes ____insufficiency, tissue infarcts & sudden ____.
marrow
bone
platelets
circulatory
death
Assessment for FAT EMBOLISM is for ____ hours post injury. S&S are HA, drowsiness, irritability, memory loss, confusion, rapid pulse, apprehension, & fever. Pulmonary symptoms include tachypnea (__ breathing), dyspnea (__ breathing), use of ____ muscles to breath, wheezing, & inspiratiory stridor. Skin manifestations may include ____ in the neck, upper chest, shoulder, axillary & buccal membranes.
12-72
fast
difficult
accessory
petechiae
Diagnosis of Fat Embolism are symptoms & Pt ____, ABG’s decreased Pa02 & PaC02 > 50 mm Hg, Acidosis, elevated ____ & an elevated sedimentation rate (ESR).

Nursing Management is to improve ____ & prevent deterioration with high ___ concentrations, adequate ___ titrated to prevent pulmonary congestion w/Dextran, administration of ____ to decrease lung inflammation & cerebral edema & ___ to prevent future formation of emboli.
history
< 60 mm Hg
lipase

oxygenation
02
hydration
Steroids
Heparin
The nurse suspects an ankle sprain when a Pt at ER:

a) is hit by another soccer player on the firld
b) has ankle pain after running a 10 mile race
c) drops a 10lb weight on his lower leg at the health club
d) has a twisting injury while running bases during a baseball game
has a twisting injury while running bases during a baseball game
The RN explains to a Pt w/ a distal tibial fracture returning for a 3 week check up that healing is indicated by :

a) callus formation
b) complete union of bone
c) presence of granulation tissue
d) formation of hematoma at fracture site
callus formation
A Pt w/a comminuted fracture of the femur is to have open reduction w/internal fixation (ORIF) of the fracture. The RN explains that ORIF is indicated when:

a) a cast would be too large to provide normal mobility
b) the Pt is able to tolerate long-term immobilization
c) adequate alignment cannot be obtained by other methods
d) the Pt cannot tolerate the discomfort of a closed reduction
adequate alignment cannot be obtained by other methods
An indication of a neurovascular problem noted during assessment of the Pt with a fracture is:

a) exaggeration of extremity movement
b) petechiae on the head of the upper thorax
c) decreased sensation distal to the fracture site
d) purulent drainage at the site of the open fracture
decreased sensation distal to the fracture site
A Pt with a stable close dfracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The RN suspects compartment syndrome & notifies the physician when the Pt experiences:

a) pain at the fracture site
b) increasing edema on the limb
c) muscle spasms of the lower arm
d) pain when the nurse passivly extends the fingers
pain when the nurse passivly extends the fingers
A Pt with symphasis pubis & pelvic rami fractures should be monitored for:

a) sudden thirst
b) changes in urinary output
c) a palpable lump in the buttock
d) sudden decrease in blood pressure
changes in urinary output
During the post-operative period, the Pt with an above the knee amputation should be instructed that the residual limb should not be routinly elevated because:

a) this position reduces the development of phantom pain
b) the flexed position can promote hip flexion contracture
c) this position promotes clot formation at the incision site & thigh
d) unnecessary movement of the extremity can cause wound dehiscence
the flexed position can promote hip flexion contracture
A Pt w/ rheumatoid arthritis is scheduled for an arthroplasty. The RN explains that the purpose of this procedure is to:

a) fuse a joint & reduce pain
b) prevent further joint damage
c) assess the extent of joint damage
d) replace the joint & improve function
replace the joint & improve function
The RN teaches a Pt recovering from a total hip replacement that it is important to avoid

a) sleeping on the abdomen
b) sitting w/ legs crossed
c) abduction exercises of the affected leg
d) bearing weight on the affected leg for 6 weeks
sitting w/ legs crossed
Sprain:
____ - hold bone to bone

Strain:
____ - hold muscle to bone
ligaments

tendons
Estrogen:
thickens bones
EVISTA is raloixfene HCL increases bone mineral ____. Used in prevention & tx of osteoporosis in ___ ___ ___.
density
post menopausal women
Didronel aka ____ is a diphosphate preparation w/ primary action on ___. It slows rate of bone ____ & new bone formation in pagetic bone lesions & in normal ____ process.
Etidronate
bone
resorption
remodeling
Fosamax aka ____ ____, inhibits ____-mediated bone resorption thus minimizing ___ of bone density.
Alendroante sodium
osteoclast
loss
Injury to ligamentous structure surrounding a joint is a:

a) strain
b) strain
c) dislocation
d) subluxation
sprain
A partial or incomplete displacement of a joint surface is a:

a) dislocation
b) sprain
c) subluxation
d) strain
subluxation
What is the most common compression neuropathy?

a) compartment syndrome
b) carpal tunnel
c) intertrochanteric fracture
d) subcapital fracture
carpal tunnel
Which motion is the most difficult for a Pt with rotator cuff injury?

a) adduction
b) abduction
abduction
Does reduction of a fracture require anesthesia?
yes
Compartment syndrome can be caused by IV infiltration.

true or false
true
Which fracture is associated with the highest mortality rate?
pelvic
What are common clinical manifestations of a hip fracture?
external rotation
shortened extremity of the affected limb
Phantom limb sensation is a rare complication of amputation occurring in less than 25% of cases.

true or false
false
Post operative, the Pt who has undergone hip replacement should be placed with their knees?
abducted