Term
| What factors influence mobility? |
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Definition
1)Developmental considerations
2)Physical health
3)Mental health
4)Lifestyle
5)Attitude and values
6)Fatigue and stress
7)External factors |
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Term
| What systems are effected by immobility? |
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Definition
1)Respiratory
2)Cardiovascular
3)Nutrition
4)Elimination
5)Musculoskeletal
6)Integumentary
7)Psychosocial |
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Term
| What complications can you suffer as a result of immobility? |
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Definition
1)Pressure Ulcers
2)Atelectasis
3)Pneumonia
4)Renal Calculi
5)Urinary Stasis
6)Constipation
7)Thrombosis & Emboli
8)Heart works harder |
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Term
| When caring for an orthopedic patient when not contraindicated, what is the best intervention? |
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Definition
| Getting them out of bed and ambulating |
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Term
| For post-menopausal women what is the best exercise?? |
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Definition
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Term
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Definition
Airway -- think of the actual airway like a tube - what could cause it to be blocked? Trauma, mucus, etc. One nursing dx is ineffective airway clearance.
Breathing -- anything having to do with the act of breathing -- respiration rate and depth (ineffective breathing pattern) or gas exchange in the lungs (ineffective gas exchange).
Circulation -- anything to do with the vascular system. Think bleeding, cardiac output, dehydration, overhydration, etc. Decreased cardiac output, fluid volume deficit/excess, risk for bleeding.
The is for Safety |
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Term
| What is the most critical assessment for the orthopedic patient? |
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Definition
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Term
| Why is a protein diet so important to orthopedic patient? |
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Definition
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Term
| What factors are important for traction? |
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Definition
Weights and counterweights
Free moving and free of obstructions |
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Term
| What factors are important postoperatively for an amputation? |
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Definition
1)Assess patient for bleeding
2)Managing pain
3)Dressing should be a compression dressing for stump shrinkage
4)Below the knee (no restrictions)
5)Above the knee (At risk for flexion contracture). Hips should be kept at less than 90 degree angle |
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Term
| When assessing a patient's mobility, what are the key characteristics of the assessment? |
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Definition
1)General ease of movement/gait
2)Alignment
3)Joint structure and function
4)Muscle mass, tone, and strength
5)Endurance |
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Term
| What are the risk factors for the development of pressure ulcers? |
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Definition
1)Dehydration
2)DM
3)Diminished pain awareness
4)Fractures
5)History of corticosteroid therapy
6)Immunosuppression
7)Multisystem trauma
8)Poor circulation
9)Previous pressure ulcers
10)Significant obesity or thinness |
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Term
| What are preventative strategies for pressure ulcers? |
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Definition
1)Assess the skin (daily)
2)Cleanse the skin routinely
3)Maintain high humidity, skin moisturizers
4)Don’t massage bony prominences
5)Barrier protection (incontinence, drainage)
6)Avoid shearing or friction
7)Assess diet, supplements
8)Mobility and activity
9)Document |
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Term
| What effects does aging have on muscle, bones, and joints? |
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Definition
1)Muscle
Decreased muscle cells, loss of elasticity
2)Joints
Increased risk for cartilage erosion
Loss of water from disks
3)Bone
Decreased bone density |
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Term
| What are some standard diagnostic tests run for orthopedic patients? |
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Definition
1)Radiology
Standard x-ray
CT
MRI
2)Bone Mineral Density
DEXA
3)Endoscopic
Arthroscopy
4)Blood
RF - Rheumatoid factor
ESR - Erythrocyte sedimentation rate
ANA - Antinuclear antibodies
5)Other
Duplex venous ultrasound |
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Term
| What are common signs and symptoms of a broken bone(s) |
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Definition
1)Pain
2)Loss of function
3)Deformity
4)False motion
5)Crepitus
6)Edema
7)Spasm |
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Term
| What are common postoperative complications to orthopedic surgery (ORIF)? |
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Definition
1)Hemorrhage
2)subluxation
3)infection
4)thromboembolism
5)avascular necrosis |
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Term
| What conditions may necessitate an amputation? |
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Definition
1)malignant tumors
2)Long-standing infections of bone and tissue that prohibit restoration of function
3)Extensive trauma to an extremity
4)Death of tissues from peripheral vascular insufficiency or peripheral vasospastic diseases such as Buerger's and Raynaud's diseases
5)Thermal injuries
6)Deformity of a limb, rendering it a useless hindrance
7)Life-threatening disorders, such as arterial thrombosis and gas bacillus infections |
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Term
| What is RICES an acronym for? |
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Definition
| Rest, Ice, Compression, Elevation, and Stabilization |
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Term
| Outline the bone repair process. |
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Definition
1)Bleeding at site of injury, clot formation
2)Osteoblasts
3)Procallus- stabilization
4)Callus
5)Remodeling |
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Term
| What are common complications that can occur from a bone fracture? |
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Definition
1)Shock
2)Fat embolism
3)Pulmonary embolism
4)Compartment Syndrome
5)Delayed bone healing
6)Infection
7)Avascular necrosis |
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Term
| What are the principles of effective traction? |
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Definition
1)Ensure continuous traction
2)Maintain countertraction
3)See the pull of traction and countertraction are in opposite directions but in straight alignment
4)Suspend splints and slings without interference
5)Be sure ropes move freely through each pulley
6)Apply the exact amount of weight prescribed
7)Make sure the weights hang freely |
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Term
| How does a nurse manage a patient in traction? |
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Definition
1)Assess the neurovascular status frequently (compare affected to unaffected)
2)Monitor the traction equipment
3)Assess for pressure ulcers
4)Mobility (overhead trapeze)
5)Assess for footdrop
6)Pin care |
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Term
| Care for a patient before a cast application? |
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Definition
1)Inspect the condition of the skin that will be covered with a cast.
2)Assess circulation,sensation,and mobility to-establish a baseline.
3)Evaluate the client’s pain level.
4)Remove clothing that will be difficult to remove after the cast is applied.
5)Explain the procedure to the client
6)Remember to tell the client that the cast will feel warm even hot as it is applied,but that it will not burn the skin. |
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Term
| Care for a patient after a cast application? |
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Definition
1)Leave the cast uncovered.
2)Assess circulation,sensation,and mobility in exposed fingers and toes every 1 to 2 hours.
3)Monitor for signs of complications related to cast application.
4)Report abnormal findings immediately.
5)Handle wet cast with the palms of the hands,not the fingers.
6)Elevate casted extremity so that it is higher than the heart.
7)Reposition the client frequently while cast is drying so that the cast dries as evenly as possible.
8)Apply ice packs to the cast where surgery was performed.
9)Circle areas where blood seeped through and write the time on the circle.
10)Petal cast edges with strips of adhesive tape to prevent chipping and to cover any remaining rough areas.
11)Replace windows in the hole from which they were cut to prevent tissue from bulging through the opening.
12)Ambulate client as soon as indicated. |
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Term
| What are appropriate teachings for a patient with a cast? |
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Definition
1)Elevation
2)Ambulation w/ crutches
3)Exercises
4)Care of actual cast
5)What to report to MD |
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Term
| What nursing guidelines should you adhere to for pin care? |
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Definition
1)Assess pin sites for redness,swelling,increased tenderness,and drainage.
2)Examine pins for signs of breakage,bending,or shifting.
3)Wearing gloves,use cotton-tipped applicators and saline or other prescribed solution,such as chlorhexidine solution,to cleanse pin sites.
4)Use at least one applicator per pin do not use applicator more than once.
5)Clean pin site from pin outward.
6)Unless there are obvious signs of infection,leave crusts around pin sites intact,as they provide a normal protective barrier.
7)Avoid applying ointment to pin sites unless specifically ordered.
8)Obtain culture if purulent drainage is present.
9)Teach client not to touch pin sites.
10)Instruct family member in pin care if client is discharged. |
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Term
| The 4 components of drug therapy for orthopedic recovery management are? |
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Definition
1)Muscle relaxants to control spasms
2)Pain management (analgesics)
3)Antibiotics to prevent infection
4)Tetanus prevention |
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Term
| What 4 components are necessary to insure adequate nutrition? |
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Definition
1)Adequate calorie intake (energy)
2)Nutrients
a)Protein 1.2 g/kg of body weight is recommended
b)Vitamins- B, C, & D
c)Electrolytes- Ca, P, Mg
3)Adequate hydration
2-3 liters/day
4)Fiber |
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Term
| Assessing for circulation, movement, and sensation (CMS) means you are checking what neurovascularly? |
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Definition
1)Color, temp & capillary refill
2)Pulses
3)Pain
4)Motor function
5)Sensory function |
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Term
| What is the normal medical surgical treatment for a patient at risk for an amputation? |
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Definition
| The patient is treated for any underlying disorder such as infection, diabetes mellitus, dehydration, electrolyte imbalances, chronic respiratory disorders, or poor nutrition |
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Term
| What are common complications resulting from an amputation? |
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Definition
| Hemorrhage, infection, hematoma, possible osteomyelitis, and causalgia (burning pain) |
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Term
| What are some signs & symptoms of RA? |
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Definition
| joint pain, swelling, erythema, stiffness, spongy tissue on joint palpation. |
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Term
| What diagnostic findings for RA? |
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Definition
| Elevated RF, ANA, & ESR results as well as cloudy,milky, or dark yellow synovial fluid. |
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Term
| Outline common drug therapy for RA with examples. |
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Definition
NSAIDs - ibuprofen
Salicylates - aspirin
COX-2 inhibitors - celebrex
DMARDs - methotrexate |
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Term
| Signs and symptoms of OA? |
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Definition
| Deep, aching pain with motion. localized stiffness, crepitus, crackling, asymmetric affect. |
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Term
| Medical Surgical mgmt of OA? |
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Definition
| Acetaminophen, NSAIDs, Corticosteroids, glucosamine and chondroitin |
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Term
| Signs and symptoms of Gout? |
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Definition
| A gout attack is characterized by a sudden onset of acute pain and tenderness in one joint.The skin turns red and the joint swells so that it is warm and hypersensitive to touch.Fever may be present.Tophi maybe palpated around the fingers,great toes,or earlobes,particularly if the client has chronic and severe hyperuricemia. |
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Term
| What are the diagnostic findings for Gout? |
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Definition
| Aspirated synovial fluid will reveal urate crystals. Urate deposits can also be identified by radiographic examination. There may also be elevated uric acid levels in serum and urine but this is not conclusive evidence of Gout. |
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Term
| What is the medical surgical management protocol for Gout? |
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Definition
| 1) Using uricosuric drugs that promote renal excretion of urates, 2) Decreasing ingestion of purine. |
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Term
| What drugs are used specifically to help with Gout? |
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Definition
1)Colchicine
2)Probenecid
3)Allopurinol |
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Term
| Colchicine is administered every 1 to 2hrs. When should the regimen be discontinued? |
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Definition
| Until pain subsides or N/V, intestinal cramping, and diarrhea develop. |
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Term
| Signs and symptoms of Osteomyelitis? |
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Definition
| high fever, chills, rapid pulse, tenderness, pain, redness, and swelling. |
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Term
| Diagnostic findings of Osteomyelitis? |
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Definition
| Elevated leukocyte count, elevated ESR, positive blood culture for infective organisms. |
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Term
| Medical Surgical Mgmt of Osteomyelitis? |
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Definition
1)Immobilization with a cast or immobilizer to decrease pain and prevent fracture.
2)The cast maybe windowed to provide access for wound care.
3)Application of warm saline soaks to the affected area for 20 minutes several times a day to increase circulation to the affected area
4)Identification of the causative organism to initiate appropriate and on going antibiotic therapy for infection control.
5)Intravenous(IV)antibiotic therapy is administered for 3 to 6 weeks.
6)Oral antibiotics then follow for as long as 3 months.
7)Surgical debridement of the necrotic tissue and sequestrum to remove the infected areas.
8)Closed irrigation with saline or an antibiotic solution and low suction to the affected area to flush away necrotic tissue
9)Antibiotic-impregnated beads maybe directly applied in the wound for 2 to 4 weeks.
10)Bone grafts for the debrided cavity to stimulate bone growth
11)Muscle flaps grafted to the affected area to enhance blood supply |
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Term
| Signs and symptoms of Osteoporosis? |
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Definition
| lumbosacral pain, thoracic pain, and bone pain and/or tenderness associated with compression fractures of the vertebrae. |
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Term
| Factors that contribute to the development of Osteoporosis? |
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Definition
1)family history
2)if you are a white woman
3)chronic low calcium intake
4)Excessive intake of caffeine
5)tobacco use
6)Prolonged corticosteroid use
7)Cushings Syndrome
8)Prolonged periods of immobility
9)hyperthyroidism
10)hyperparathyroidism |
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Term
| Diagnostic findings of Osteoporosis? |
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Definition
| 1)DEXA (Dual energy x-ray absorptionmetry) test measures significant bone mineral density loss 2)Quantitative ultrasonic studies (QUS)or bone sonometer measures heel density losses for baseline data |
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Term
| How is Osteoporosis managed medically? |
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Definition
1)A diet rich in calcium and vitamin D
2)Mild analgesics for pain
3)Medications (Biphosphonates, calcitonin, SERMs (Evista), Teriparatide(Forteo), and Tamoxifen (Nolvadex) |
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Term
| Nursing management for Osteoporosis? |
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Definition
1)Nurse educates patient on a diet rich in Vitamin D, calcium, and protein.
2)Activity that promotes bone formation (weight-bearing) such as walking. |
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Term
| Signs and symptoms of Osteomalacia? |
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Definition
| Bone pain, weakness, tenderness in bones upon palpation. |
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Term
| Diagnostic findings for Osteomalacia? |
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Definition
1)A bone scan detects increased and decreased areas of bone demineralization.
2)Serum levels of calcium and phosphate are low
3)Alkaline phosphate levels are typically elevated |
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Term
| Medical and surgical management Osteomalacia? |
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Definition
1)Supplements of calcium, phosphorus, and vitamin D
2)Bone deformities (Bowed legs) may require braces or surgery for correction |
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Term
| Nursing management for Osteomalacia? |
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Definition
1)Educate the patient about medications to relieve pain and discomfort.
2)Allows client to verbalize self-concept issues regarding deformities. |
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Term
| Why shouldn't a patient that has gout take salicylates? |
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Definition
| Because they deactivate uricosuric drugs which promote renal excretion of urates. |
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