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112 Cards in this Set

  • Front
  • Back

S/S Fracture

-pain (not always)




-loss of function

-decreased sensation



Time frame for bone healing

14 days - 1 year

Closed reduction vs. open reduction

CLOSED: Bone externally manipulated into position & immobilized with a bandage, cast or traction (without surgery) - ORIF

OPEN: Bone surgically exposed& realigned - OREF

Purpose of a cast; types of Casts

External immobilization of affected structures

-plaster of paris - heavier, intact longer

-synthetic - lighter, dries quickly, more freedom

Nursing Considerations with Ortho

-elevate cast

-neurovascular assessment

-manage pain

-ice for 10-15 min

-turning pt. - skin integrity

-teaching about positioning

-teach dalteparin injection

Cast Assessment



-skin integrity



-neurovascular assessment

What is traction?

-extend and hold body part in specific position

-uses ropes, pulleys and weights attached to a fixed point below injury

-force of pull from weights is exerted on bone

Why are the elderly at risk for hip fractures?

-decreased reaction time

-failing vision

-lessened agility

-decreased muscle tone


*1/3 of post-op hip replacement elderly pt. die

Total Hip Replacement (THP, THA)

Acetabulum: Polyurethane socket

Femur Head: metallic replacement

Femoral Canal: stem of prosthesis femoral canal

Hip Precautions

-don't lift knee above hip (>90 degrees)

-don't cross legs

-don't adduct past midline

-don't twist legs

-don't use low chairs

-don't take long strides

Ortho Complications

-compartment syndrome




-fat embolism

-dislocation of prosthesis

6 P's of compartment syndrome

-paresthesia (tingling or numbness)

-pain (that opioids don't help)

-pressure - increased

-pallor - coolness


-pulselessness (diminished/absent pulses)

Benign Prostatic Hypertrophy


-Men >50years at risk

-Enlargement of the prostate gland

-R/T hormonal changes









-Decreased force of stream

Complications of BPH

-Increased pressure in bladder

-Stasis in bladder…infection


-Renal insufficiency…failure

Diagnosing BPH

DRE: Digital rectal exam

Men>40 yrs should have DRE done annually

PSA:Prostate Specific Antigen

(Blood test)-Increased with BPH (PSA is even higher with cancer)


Transurethral prostatic resection(TUPR/TURP)

-Preferred method;

-fast recovery

-Less complications

-Removes inner portion of prostate, via urethra, with use of endoscope

-Best for removal of small amounts of tissue

-Spinal anesthetic


-Proscar (Finasteride): decreases PSA and slows growth

-Flomax CR (Tamulosin Hydrochloride): relaxes muscles in prostate and bladder – enables more complete bladder emptying

Temporary solutions / procedures:

-A catheter with a balloon is inserted into the urethra and inflated where urethra is narrowed by enlarged prostate – balloon is removed at the end of treatment procedure

-Stents may also be used to widen urethra – these need to be changed regularly(inserted as collapsed than opened as cylindrical tubes inside urethra)

Prostate Cancer

- 2nd most common cancer in men

-2nd leading cause of death Occurs>50yrs age; peak at 75Commonlymetastatic

-Requires radical surgery and radiation; androgen suppression

-Removal of prostate and adjacent tissues if tumour invasive

-High risk of impotence; incontinence

Bladder Tumours

-Common in men 50-70 yrs; as well as women

-May require trans urethral resection of bladder tumour; cystotomy and resection of the bladder

Post-op TURP

-Risk for DVT


-fluid overload





Why use CBI?

-To prevent clot formation and prevent obstruction

-Slows bleeding (d/t coolness and pressure from fluid influx)

-Often up to 24hrs post-op; depending on color of returns

Rate of CBI

-Irrigates 0.9% NS, through bladder, via triple lumen catheter

-Rate of flow runs according to returns…rapid (wide open), moderate, slow.

-Initially fast, then moderate/slow, as returns become lighter in color

*Use nurses judgement

CBI Assessments

-Bed rest (flat) until CBI d/c’d(easier fluid evacuation and decrease clot buildup & less pressure on operative site)

-Monitor returns for bleeding/clots and color of returns; constant flow Hydrate patient; VS

-Check irrigation bags and returns frequently; Bags staggered and should not empty

-May need to change bags q20-40 min

-Empty drainage bag/ bucket frequently

-Check tubing for kinks

-Slow irrigation as returns become pink

Pt assessments with CBI

-Assess bladder


-Slight distension/firm?

-Normal to feel bladder fullness and need to void

-Acute pain abnormal; obstruction?

-Can relieve spasms with B&O supps

-DVT-Homan’s sign? Calves?

-Excessive bleeding? Hemorrhage? Clots?

24-36 hours post-op CBI

CBI d/c’d…when returns are light pink

-Ambulate after CBI d/c’d; cautiously

-If bleeding occurs/persists-rest; increase fluids, decrease activity

Post-CBI Teaching

-Increase fluids

-Assess urine flow, color…

-Avoid heavy lifting; prolonged sitting for 4 – 6 weeks (pressure may cause bleeding)

-Mild burning when urinating

-Avoid constipation

-Call physician if fever; severe burning; dysuria; bright red urine; blood clots in urine

-No sex for 6 weeks (pressure may cause bleeding)

Terminal signs of increased ICP


-bilaterally fixed and dilated pupils

-respiratory arrest

-absence of motor response (flaccid)

Late Signs of increased ICP

-decreased LOC

-unilateral or bilateral pupilary changes

-ineffective breathing pattern

-abnormal motor response - decorticate or decerebrate

Early signs of increased ICP

-altered LOC

-unilateral pupil change in size, equality and or reactivity

-altered resp pattern

-unilateral hemiparesis

What happens earlier than decreased LOC

LOC changes

What happens to the pupils when cranial nerve is compressed?

pupils dilate and become more sluggish

What are you testing with verbal response?

-long term memory

-short term memory

-interemdiate memory

Pronator Drift

Pt sitsor stands with eyes closed, arms out straight, slightly lateral, palms up.Watch for drift of the arms out of position. (Symtpomaticof cerebellar damage – proprioception = unconscious perception of movement andspatial orientation)

One side of brain swells - pupils?

same side pupil will dilate

Motor Response - Localizes

nurse squeezes trapezius on each side. pt attempts to move opposite hand towards affected tapezius

Motor Response - Withdraws

pt withdraws from a pain stimulus to all 4 limbs

Motor Response - Flexion

-decorticate posturing with trapezius squeeze

If you can't wake pt, what do you do?

Call a code

Motor Response - Extension

Decerbrate posturing with trapezius squeeze

PERL (for GCS assessment)

Pupils equal and reactive to light

Seizure Precautions

1. Padded Side Rails

2. Suction and O2 available

3. IV insitu

4. Oral Airway

What is ORIF?

-open-reduction internal fixation- Incision closed with staples

- May or may not have drain in place

What is OREF?

-Open-reduction external fixation

-immobilizes bones to facilitate healing

-surgeon percutaneously places pins or screws into the bone on both sides of the fracture

-pins are secured together outside the skin with clamps and rods (i.e. the "external frame”)

What are some assessments and interventions with a patient with a cast?

1) Neurovascular assessment

2) Pain…types of medications: opioids

3) Edema…elevate above heart

4) Skin care at edges…actions?

5) Foul odour…S & S of infection...take V/S, check labs for infection, inform surgeon

6) Itchiness…actions?

7) Documentation

Necrotizing fasciitis

- commonly known as flesh-eating disease

- is a rare infection of the deeper layers of skin and subcutaneous tissues which easily spreading across the fascial plane within the subcutaneous tissue

- is a severe disease of sudden onset that progresses rapidly


- weakness and wasting of the body due to severe chronicillness

Chemo precautions

-the need to protect the patient from the outside world (positive pressure room to keep air from outside out)

-PPE to be worn by staff and visitors

review of how to clean a wound

from clean to dirty (center, side, side)

Is it okay for LPNs to d/c a wound drain?

YES (according to CLPNBC), but check facility policy and also WITH A DOCTORS ORDER, of course!

What are 4 types of Sking/Wound closure procedures?

1) skin glue (for small tears like on a finger)

2) steristrips

3) staples (surgical clips)

4) sutures

What is the purpose of having a wound closure?

to close surgical wounds & to repair lacerations

*Goal is to promote healing by primary intent.*

What is primary intent?

-wound edges come together neatly

-stops any bleeding

-preserves tissue function

-prevents infection

-restores cosmetic appearance

-promotes rapid healing

-this type of healing is usually from a surgical incision, not laceration

What are the phases of wound healing?

Inflammatory Phase: 0-4 days

Proliferation Phase: 5-21 days

Maturation Phase: up to 1 year

What is secondary intention healing?

-wound edges are not well approximated

-takes way longer to heal that primary intention

-usually seen with a laceration (instead of surgical incision)

-scarring will be more evident

-may have increased chance of being dirty/contaminated (higher risk of infection)

Patient teaching for wound healing

-Nutrition: increase vit C & protein to speed healing time up

-splinting when moving around, coughing to prevent dehisence

When you have an order to d/c staples/sutures, what should you check?

*Use Nrg Judgment when assessing wound prior to removing sutures/staples.

-check dr's order/facility policy

-assessment (edema, infection, no dehisence)

-if wound starts to open, STOP!!

-take sutures/staples out alternately, to see how wound will take it

-apply steristrips to reinforce where the staples/sutures were

-document how many were taken out

types of sutures

1) continuous (LPNs cannot remove these!)

2) Interrupted (similar to staples - we can remove these!)

3) Retention - rubber or elastic (LPNs cannot remove these either!!)


-a portable wound suction device that is compressed to provide gentle suction

- an internal spring slowly expands to create a negative suction pressure of approximately 45 mg Hg.

-enhances healing by removing fluid or air from the peri-wound area

-suction is lost as drainage accumulates (empty regularly)


-small wound drain that uses negative pressure to draw out drainage from a wound

-enhances healing by removing fluid or air from the peri-wound area

-suction is lost as drainage accumulates (empty regularly)

Penrose Drain

-no suction, passive drainage

-drains onto gauze surrounding drain sponge

-surgeon will say when to pull/cut drain sponge

-REMEMBER to pin drain sponge to gauze, as it could slip into wound if not secured!

What types of acute or chronic conditions put someone at higher risk for dehiscense?


-DM - longer healing time



-poor nutrition

-life style


-Resp issues

-other infection


What is the difference between a complex and surgical wound?

Complex - secondary intention: longer healing time, may need packing, more frequent changes

Surgical - primary intention: faster healing time

What are you assessing when emptying a wound drain system?

1) Colour

2) amount

3) consistency/substance (clots or other debris)

4) odour

5) that the drain is insitu

6) that suture is in place (if you are changing dressing)

What are 4 potential complications an LPN might observe for in surgical wound?

1) infection

2) dehiscence

3) eviseration

4) hematoma

What is tertiary intention?

-delayed primary intention

-wound is left open to drain toxins, and then will be closed when infection

What do you do if you are doing your QPA and your patient is falling asleep, or cannot be woken up?

DO NOT MOVE ON!! This needs to be resolved before moving to other assessments.

What is one thing you can tell your patient to raise their oxygen level?

Deep breathing and coughing exercises

How do you measure a wound?

Length (head to toe direction)

Width (from side to side)

Depth (use sterile cotton-tipped applicator to measure)

Description of surrounding skin of wound...

Intact, macerated, hard, red, scaly

what is maceration?

the softening and breaking down of skin resulting from prolonged exposure to moisture.

What is exudate?

is any fluid that filters from the circulatory system into lesions or areas of inflammation (It can be a pus-like or clear fluid)

what is sanguineous drainage?

-This type of wound exudate is also known as the fresh blood that comes from a recent wound, and is characterized by a bright red color

-Most commonly, it is seen in partial thickness and full thickness wounds.

what is serous drainage?

bodily fluids that are typically pale yellow and transparent

What is serosanguineous drainage?

-containing or relating to both blood and the liquid part of blood (serum)-it usually refers to fluids collected from or leaving the body (fluid leaving a wound that is serosanguineous is yellowish with small amounts of blood)

What is purulent drainage?

consisting of, containing, or discharging pus.


-Localized hardening of soft tissue of the body

-The area becomes firm, but not as hard as bone


-the process of removing nonliving tissue from pressure ulcers, burns, and other wounds.

-LPNs can only rinse out wounds, no surgical removal of necrotic tissue (RNs/Wound care RNs would be doing this - collaboration)

Discharge Teaching

-Keep dressing clean and dry

-Splint area before coughing

-Good nutrition, adequate rest

-Call MD or go to ER if:

Excessive bleeding

Redness, pain, excessive swelling

Increased or foul smelling exudate


Flu-like symptoms


bleeding that is trapped within tissues or organs


dead tissue that has been shed


soft pink/red tissue comprised of capillaries and fibrous collagen


a cavity containing pus and surrounded by inflamed tissue, formed as a result of localized infection


drawing two tissue surfaces close together as in the repair of a wound


the separation of a surgical incision or rupture of a wound closure, typically an abdominal incision.


the regrowth of skin over a wound


the protrusion of an internal organ through a wound or surgical incision, especially in the abdominal wall


localized tissue death that occurs in groups of cells in response to disease of injury

vacuum assisted closure (VAC)

-a dressing or filler material is fitted to the contours of a wound (which is covered with a non-adherent dressing film) and the overlying foam is then sealed with a transparent film

-A drainage tube is connected to the dressing through an opening of the transparent film. A vacuum tube is connected through an opening in the film drape to a canister on the side of a vacuum pump


-pieces of stainless steel wire that are used to close certain surgical wounds


-surgical stitches taken to repair an incision, tear, or wound

-material used for sutures are silk, catgut, wire, or synthetic material

chest tube clamps

called "Kelly Clamps" - RNs use these when there is a suspected air leak in the chest tube system

mediastinal shift

-The build-up of pressure in the pleural cavity causes the mediastinum (which contains the heart, trachea, esophagus and great vessels) to shift to the unaffected side

-also causes compression of the lung on the unaffected side.

-also called "Flail Chest"

What is the purpose of a chest tube?

to remove air/fluid from the pleural space and to restore normal intra pleural pressure so that the lungs can re-expand

-also used to measure drainage from lungs

Types of chest tube drainage systems

Wet (collection chamber, water seal chamber, suction control chamber)

Dry (contains no water, but works similarly by having a regulator to dial the desired negative pressure (ex:Heimlich Valve)

collection chamber

-receives fluid and air from the chest cavity

-fluid stays in this chamber while air vents into the 2nd compartment

water seal chamber

-contains 2cm of water, acting as a one-way valve

-incoming air from the collection chamber bubbles up through the water

suction control chamber

applies controlled suction to the chest drainage system by regulating the negative pressure when it exceeds a certain pressure

pleural effusion

-an abnormal accumulation of fluid in the intra pleural spaces of the lungs

-characterized by: chest pain, dyspnea, adventitious lung sounds, nonproductive cough


a collection of blood in the pleural cavity


-the presence of air or gas in the pleural space, causing a lung to collapse

-characterized by: sudden sharp chest pain, followed by rapid breathing, decreased breath sounds and cessation of normal chest movements of the affected side; tachycardia, diaphoresis, elevated temp, dizziness, anxiety

negative pressure

a less than ambient atmospheric pressure, such as in a vacuum

negative pressure isolation rooms

-used for patients with an airborne transmitted disease

-airflow goes from the corridor into the patients room, and is then exhausted/vented outside


a wavelike motion of fluid in a body cavity or apparatus

air leak

-indicated by rapid, vigorous bubbling in the water seal

-consistent with a tear in the pleura, bronchopleural fistula, or a crack or leak in the drainage system

tension pneumothorax

-characterized by: chest pain and resp distress, tachycardia, tachypnea in the initial stages; quieter breath sounds on one side of the chest, low O2 SAT and BP, and displacement of the trachea away from the affected side


surgical incision into the chest wall.


is the thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung.

intrapleural space

-place between the parietal and visceral pleura

-also called pleural cavity


the collection of pus in a cavity in the body, especially in the pleural cavity.

valsalva maneuver

-the action of attempting to exhale with the nostrils and mouth, or the glottis, closed

-This increases pressure in the middle ear and the chest, as when bracing to lift heavy objects, and is used as a means of equalizing pressure in the ears

the purpose of a neurovascular assessment

-a systematic approach for recognizing neurological &/or circulatory impairment of an extremity

-used by nurses to assess pulses, CWMS, cap refill,radial nerve, ulnar nerve, median nerve, femoral nerve, peroneal nerve, tibial nerve