Chp 27

Question 1

Amputate

Answer 1

To remove a limb surgically

Question 2

Continuous passive motion (CPM) machine

Answer 2

A machine designed to gently flex the patient’s knee according to the number of degrees of flexion on the setting and then gently extend the knee

Question 3

External fixators

Answer 3

The wires, pins, tongs, and rods that may be used in skeletal traction

Question 4

Fracture

Answer 4

A break in a bone

Question 5

Joint Replacement (Arthroplasty)

Answer 5

Surgery to remove damaged articular bone surfaces and replace them with metal and plastic surfaces

Question 6

Osteoarthritis

Answer 6

A disorder that causes degeneration and inflammation of joints over time

Question 7

Physical Therapist

Answer 7

A health care team member responsible for assessing musculoskeletal deficiencies and developing the plan of care to strengthen muscles and restore motility

Question 8

Prosthesis

Answer 8

An artificial limb, such as an arm or leg

Question 9

Skin traction

Answer 9

A type of traction in which the limb is wrapped with an elastic bandage or fitted with a velcro wrap to which the frame is attached

Question 10

Skeletal traction

Answer 10

A type of traction in which pins, screws, or tongs are surgically inserted into the bone

Question 11

Spica

Answer 11

A cast that encases the hips and one both legs

Question 12

Sprain

Answer 12

An injury to a joint that results in damage to muscles and ligaments. Severe sprains may cause ligaments to be completely

Question 13

Stump

Answer 13

The remaining portion of a limb after amputation

Question 14

Immobilization Devices

Answer 14

• Abductor pillow
• Cast
• Elastic bandages
• Amputee compression sock
• Immobilizer
• Splint
• Traction

Question 15

Abductor pillow

Answer 15

Wedge-shaped foam pillow, often with Velcro straps, placed between the legs of patients who have had total hip replacement surgery; keeps hips abducted while patient is in bed; straps keep the pillow in place and prevent shifting

Question 16

Cast

Answer 16

Hard plaster or fiberglass encasement for a limb; used to immobilize joints, usually to stabilize fractures until they heal; sometimes used to immobilize severely sprained joints until healing can occur; often used after musculoskeletal surgeries to stabilize the joint and surgical sites

Question 17

Elastic Bandages

Answer 17

Woven bandage containing elastic to stretch as it is wrapped around an injured area; elastic helps compress the area to decrease edema

Question 18

Amputee Compression Sock

Answer 18

Also called a “shrinker sock”, elastic sock or sleeve that fits snugly over a stump to help decrease edema and help it heal in a shape to fit the prosthesis

Question 19

Immobilizer

Answer 19

Soft fabric with firm internal stays; opens and closes with Velcro fasteners; used to protect an injured limb and to keep its joints from flexing; often a boot for foot or ankle injuries

Question 20

Splint

Answer 20

Firm plastic molded form used to keep a joint or joints from flexing; may be applied to a limb and wrapped in place with gauze or an elastic bandage; sometimes “air splints” are used when transporting injured patients; can be slipped beneath the injured limb, wrapped around it, then inflated to immobilize the joint

Question 21

Traction

Answer 21

Skin traction: Involves the use of ropes, pulleys, and weights to align bone ends after a fracture
Skeletal traction: Uses wires, rods, or tongs that penetrate the skin and subcutaneous tissue and inserted into the bone

Question 22

Common crutch walking gaits

Answer 22

Two-point gait
Three-point gait
Four-point gait
Swing-to gait
Swing-through gait

Question 23

Two-point gait

Answer 23

For patients who are able to bear partial weight on the affected limb; patient moves one foot and the opposite crutch forward at the same time , and then moves remaining foot and crutch forward

Question 24

Three-point gait

Answer 24

For patients who are unable to bear weight on the affected limb; patient moves both crutches and the affected foot forward at the same time without touching down or placing weight on it, and then brings the unaffected foot forward

Question 25

Four-point gait

Answer 25

For patients able to bear weight on the affected limb; patient moves the first crutch forward and then the opposite food forward ; patient then moves the remaining crutch forward and then the remaining affected food forward

Question 26

Swing-to gait

Answer 26

For patients able to bear weight on the affected limb; patient stands on both feet and moves both crutches forward at the same time; patient then swings both feet forward to the level of the crutches

Question 27

Swing-through gait

Answer 27

This is the same as the swing-to gait except that the patient swings both feet forward beyond the level of the crutches

Question 28

Three types of ambulatory devices

Answer 28

- Crutches - Canes - Walkers (knee walkers)

Question 29

Crutches

Answer 29

- Used when a patient is unable to bear full weight on a lower limb - Patient may be restricted to partial weight bearing or no weight bearing - 3 finger breadths below the axilla - Tips 4 to 6 inches to the side of the heel

Question 30

Canes

Answer 30

- A cane is used when a patient can bear weight on the affected leg but needs extra support while ambulating - Ensure that the patient holds the cane on the unaffected side - Ensure patient moves affected leg and the cane forward and then the unaffected leg - Erect not leaning over the cane - A single prong cane,Multi prong canes: three pronged tip- tripod, four pronged tip- quad cane

Question 31

Walkers

Answer 31

-Used by patients who can bear full weight on both legs but need assistance maintaining balance

Question 32

Knee Walkers

Answer 32

Helpful for patients who can't bear weight on a foot or an ankle

Question 33

Nursing interventions related to the care of a client in traction

Answer 33

- Pin site care - Ensure that the weights hang freely and do not rest on the floor - Ensure that ropes pull in a straight line without crossing one another - Assess for skin breakdown beneath the external traction devices - When turning a patient in traction, have another person lift up on the weights, causing slack in the ropes while the patient is turned. After the patient is supported and aligned , the second person then slowly and gently releases the weights to hang freely - Ensure that the patient's body is in proper alignment so that the traction pulls correctly

Question 34

Applying an elastic bandage

Answer 34

Skill 27.3 (pg 571)

Question 35

Guidelines for Caring for Patients With Partial and Total Knee Replacements

Answer 35

- Ensure that the patients pain is managed - Set the degrees of flexion on the CPM machine according to the physicians orders - Follow orders exactly regarding the length of time the CPM machine is to be in use and advancing the degrees of flexion - Assist the patient in and out of bed using a walker or other assistive device - Follow the physicians orders regarding the amount of weight bearing allowed on the operative knee

Question 36

Guidelines to follow when caring for patients who have had total hip replacements

Answer 36

- Avoid hip flexion beyond 90 degrees - Keep the abductor pillow in place while patient is in bed - Avoid turning patient on operative side, according to physician orders - Assist patient out of bed carefully - Ensure patient calls for help if any items are dropped and that the patient does not lean forward - Assist patient to get up from chair or bedside commode without leaning forward

Question 37

Caring for a patient after amputation

Answer 37

- physical care: rehabilitation - emotional support - Observe to make sure it is healing well

Question 38

Guidelines for Nursing Care of Dry Casts

Answer 38

- Teach the patient to avoid putting anything between the cast and the skin beneath, especially to scratch - Observe for any drainage staining the cast or any malodorous discharge, which indicates infection. - Asses circulation to the casted limb - Place tape “petals” over the edge of the cast if they begin to crack or crumble over time. - Cast of all materials are being used less, with removable boots and splints favored more by HCP and patient

Question 39

Guidelines for Nursing Care of a Plaster Cast that is not yet dry

Answer 39

- Support the limb on pillows in such a way that air circulates all around the cast for even drying - Avoid touching the wet or damp cast with your fingers because they can leave dents in the cast, causing pressure points in the skin beneath - use palm of hands to touch cast

Question 40

Plaster casts or splints

Answer 40

- Often applied initially after a fracture or surgery because they mold easier to a precise shape - Plaster is the material of choice when bone realignment is necessary to keep the bone in place

Question 41

Fiberglass casting

Answer 41

- Often applied a week or two after injury because it is more durable once the bone starts - May also be used if the fractured bone is not out of position - Allows for better air circulation, is lighter in weight, and is penetrated better by x-rays for clearer visualization of the healing bone.

Question 42

List key factors regarding neurovascular checks for the client with musculoskeletal injuries

Answer 42

P570 | Skill 27.1