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116 Cards in this Set
- Front
- Back
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The reconstruction or placement of a joint?
a)OSEOTOMY b)ARTHROPLASTY c)SYNOVECTOMY d)SUBLAXATION |
ARTHROPLASTY
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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
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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
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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
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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
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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
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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
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A partial or incomplete displacement of the joint surface is?
a)CARPAL TUNNEL SYNDROME b)COMPARTMENT SYNDROME c)REPETITIVE STRAIN INJURY d)SUBLAXATION |
SUBLAXATION
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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
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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
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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
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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
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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
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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
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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
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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
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A partial or incomplete displacement of the joint surface:
a)SUBLAXATION b)CARPAL TUNNEL SYNDROME c)BURSITIS d)COMPARTMENT SYNDROME |
SUBLAXATION
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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
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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
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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
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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
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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 ! |
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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.
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ligament
Inflammatory nerves or vessels joint |
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Assessment of swelling, pain, ecchymosis, limited joint movement, warmth, & snapping sound at injury indicates a:
a)strain b)subluxation c)sprain |
sprain
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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. |
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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
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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
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A sprain is worse than a strain?
true or false? |
true
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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 |
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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 |
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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.
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ankle
wrist x-ray |
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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
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Health promotion stresses the importance of ___ exercises before vigorous activity to reduce __ & __.
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warm-up
sprains & strains |
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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
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A dislocation is a ___ displacement or ___ of the articular surfaces of a joint.
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complete
separation |
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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.
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contact
shoulder patella |
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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 ___ ___.
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a visable deformity
cool decreased cap refill |
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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 ___ ___.
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vascular
neurovascular IMMEDIATE ATTENTION |
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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.
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emergency
necrosis airway, breathing & circulation neurovascular x-rays tetanus |
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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 |
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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 |
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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.
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Phalen’s sign (phalen flex)
Tinels Sign (shooting tinel) |
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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 ___.
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fibrocartilage
squatting or kneeling avascular & aneural atrophy arthrogram, arthroscopy, MRI arthroscopy |
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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 |
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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 |
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Name 4 children’s fractures:
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Bends (boxer’s FX)
Buckle (tores fx) Greenstick complete |
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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.
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compound fracture
simple fracture |
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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
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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)
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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
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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
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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
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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" |
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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
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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.
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metal or plastic
20 pain ROM |
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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) ___, ___, ___.
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metal or plastic
20 – Pain relief – Increased ROM – Improved motor fxn |
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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 +
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Predisposing factors for the occurrence of hip fractures are diminished ___, slow ___. muscle ____, diminished bone strength as a result of ____.
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equilibrium
reflexes atrophy osteoporosis |
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Hip fractures are more common in women due to osteoporosis than in men.
true or false |
true
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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%
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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.
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femur
intracapsular head neck fall outside lesser below |
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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 ___.
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rotation
extremity fracture discoloration supine repair fixation |
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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.
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fracture
rheumatoid arthritis alcohol |
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Benefits of joint replacement
are decreased ____, increased ____, & increased ____. |
pain
strength mobility |
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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 |
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Name 3 Nursing "PRE-OP" interventions for a joint replacement.
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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) |
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Name 5 Nursing "POST-OP" interventions for a joint replacement:
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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 |
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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 |
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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.
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turn, cough, deep breath
infection Fever redness WBC TED night return demonstration incision bleeding unaffected |
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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 & ___.
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cross
turned in low chair lean bending un-operated put shoes on 90 pants |
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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 ___.
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sit
help stairs car |
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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 ___.
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backing
touch front |
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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 |
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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
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good
operated operated "UP w/the GOOD - DOWN w/the BAD" |
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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 |
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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.
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knee
impact strength sitting |
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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.
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HOB
new tighten kneecap ground 5 |
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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.
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new
straighten 5 bend hold |
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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).
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vascular
mellitus atherosclerotic INFECTION |
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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.
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positive
open callus bubbles decreased septic purulent |
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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 ___.
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Open
Closed closed open infection |
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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.
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present
months to years exercise diversion |
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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 ___.
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hemorrhage
bottom and back dressing sterile infection shape the stump above below 24 contractures alignment sitting q 4-6 straigtens flexed |
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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 & ___.
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elastic wrap
wrapping Q 4-8 smooth bathing |
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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.
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pressure
re-use bacteriostatic 20 prescribed sock daily ROM upper elevate prone 3-4 |
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Movement of a prosthetic device below the knee takes ___% more energy & ___% more if prosthetic is above the knee.
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40%
60% |
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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 |
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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 |
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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. |
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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 ____.
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marrow
bone platelets circulatory death |
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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.
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12-72
fast difficult accessory petechiae |
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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 |
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Sprain:
____ - hold bone to bone Strain: ____ - hold muscle to bone |
ligaments
tendons |
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Estrogen:
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thickens bones
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EVISTA is raloixfene HCL increases bone mineral ____. Used in prevention & tx of osteoporosis in ___ ___ ___.
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density
post menopausal women |
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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.
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Etidronate
bone resorption remodeling |
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Fosamax aka ____ ____, inhibits ____-mediated bone resorption thus minimizing ___ of bone density.
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Alendroante sodium
osteoclast loss |
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Injury to ligamentous structure surrounding a joint is a:
a) strain b) strain c) dislocation d) subluxation |
sprain
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A partial or incomplete displacement of a joint surface is a:
a) dislocation b) sprain c) subluxation d) strain |
subluxation
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What is the most common compression neuropathy?
a) compartment syndrome b) carpal tunnel c) intertrochanteric fracture d) subcapital fracture |
carpal tunnel
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Which motion is the most difficult for a Pt with rotator cuff injury?
a) adduction b) abduction |
abduction
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Does reduction of a fracture require anesthesia?
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yes
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Compartment syndrome can be caused by IV infiltration.
true or false |
true
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Which fracture is associated with the highest mortality rate?
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pelvic
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What are common clinical manifestations of a hip fracture?
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external rotation
shortened extremity of the affected limb |
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Phantom limb sensation is a rare complication of amputation occurring in less than 25% of cases.
true or false |
false
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Post operative, the Pt who has undergone hip replacement should be placed with their knees?
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abducted
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