Exam 4: Chapter 40 - Musculoskeletal Care Modalities Flashcards
(143 cards)
1
Q
A cast is a
A
rigid external immobilizing device that is molded to the contours of the body.
2
Q
Most common casting materials consist of
A
fiberglass or plaster of Paris, as these materials can be molded
3
Q
Pressure areas in arm in cast?
A
Ulna Styloid, Radial Styloid, Olecranon, Lateral Epicondyle
4
Q
avascular necrosis
A
death of tissue due to insufficient blood supply
5
Q
Cast syndrome
A
psychological (claustrophobic reaction) or physiologic (superior mesenteric artery syndrome) responses to confinement in body cast
6
Q
external fixator
A
external metal frame attached to bone fragments to stabilize them
7
Q
heterotopic ossification
A
misplaced formation of bone
8
Q
naurovascular status
A
neurologic (motor and sensory components) and circulatory functioning of a body part
9
Q
osteolysis
A
lysis of bone from inflammatory reaction against polyethylene particulate debris
10
Q
osteomyelitis
A
infection of the bone
11
Q
msteotomy
A
surgical cutting of bone
12
Q
paresthesia
A
an abnormal sensation of tingling or numbness or burning
13
Q
the patient may require a tetanus booster if the wound is dirty and if the last known booster was given more than _____ years ago
A
Five
14
Q
the main concern following the application of an immobilization device is assessment and prevention of neurovascular dysfunction or compromise of the affected extremity. Assessments are performed at least every _____ for the first 24 hours and every _____ to _____ hours thereafter to prevent neurovascular compromise related to edema and/or the device
A
Hour
1-4
15
Q
the 6 “P’s” indicative of neurovascular compromise are:
A
Pain Poikilothermia Pallor Pulselessness Paresthesia Paralysis
16
Q
to augment the flow of fluid, the nurse elevates the extremity so that it is above the level of the heart during the first _____ to _____ hours postapplication to enhance arterial perfusion and control edema and notifies the primary provider at once if signs of compromised neurovascular status are present
A
24-48
17
Q
pain associated with the underlying condition (eg _____) is frequently controlled by immobilization
A
fracture
18
Q
pain due to edema that is associated with trauma, surgery or bleeding into the tissues can frequently be controlled by _____ and if prescribed, intermitten application of ice or cold packs
A
elevation
19
Q
pain associated with _____ _____ is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual doses of analgesic agents
A
compartment syndrome
20
Q
severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending _____ _____. This may also occur from too tight elastic wraps used to hold splints in place
A
pressure ulcer
21
Q
the nurse must never ignore complaints of pain from the patient in a cast because of the possibility of problems such as impaired tissue perfusion, compartment syndrome or pressure ulcer formation. A patients unrelieved pain and increasing analgesic requirements must be reported immediately to the _____ _____ to avoid necrosis, neuromuscular damage and possible paralysis
A
primary provider
22
Q
while the cast is on the nurse observes the patient for systemic signs of _____, which include an unpleasant odor from the cast, splint or brace and purulent drainage staining the cast. If the infection progresses, a fever may develop. The nurse must notify the _____ _____ if any of these signs occur
A
Infection
Primary Provider
23
Q
Every joint that is not immobilized should be exercised and moved through its range of motion to maintain function. The nurse encourages the patient to move all fingers or toes _____ when awake to stimulate circulation
A
Hourly
24
Q
_____ _____ - the most serious complication of casting and splinting- occurs when increased pressure within a confined space (eg cast, muscle compartment) compromises blood flow and tissue perfusion. Ischemia and potentially irreversible damage to the soft tissues within that space can occur within a few hours if action is not taken. A tight or rigid cast/splint that constricts a swollen limb is associated with this complication.
A
compartment syndrome
25
diagnosis of _____ _____ is based on clinical suspicion, assessment of the 6 P's (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis) and intracompartmental pressure (ICP)
compartment syndrome
26
the earliest indicator of developing _____ _____ is pain that seems out of proportion to the underlying injury and pain on passive stretch of other muscles in the immobilized limb. The patient may complain that the cast, brace or splint is too tight. The primary provider must be notified immediately as a delay in diagnosis increases the risk of failed treatment, poor outcomes, additional operations and the possibility of amputation.
Compartment syndrome
27
pulselessness, paresthesia, and complete paralysis are found in the late stages of _____ _____
compartment syndrome
28
if compartment syndrome is due to a cast or tight splint may be loosened or removed and the cast cut to release constriction and allow for inspection of the skin. The nurse assists in maintaining limb alignment, and the extremity must then be elevated no higher than the _____ to maintain arterial perfusion. If pressure is not relieved and circulation is not restored an emergent surgical fasciotomy may be necessary to relieve the pressure within the muscle compartment
heart
29
casts or splints can put pressure on soft tissues, particularly if they are inappropriately applied, causing tissue anoxia and pressure ulcers. _____ extremity sites most at risk are the heel, malleoli, dorsum of the foot, head of the fibula, and anterior surface of the patella. The main pressure sites on the _____ extremity are located at the medial epicondyle of the humerus and the ulnar styloid.
lower
upper
30
if pressure necrosis occurs, the patient typically reports a very painful _____ _____ and tightness under the cast. The cast may feel warmer in the affected area, suggesting underlying tissue erythema. Drainage may stain the cast or splint and emit an unpleasant odor
hot spot
31
immobilization in a cast, splint or brace can cause muscle atrophy and loss of strength, and can place patients at risk for _____ _____, which is the deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity
disuse syndrome
32
to prevent disuse syndrome the nurse instructs the patient to tense or contract muscles (isometric muscle contraction) without moving the underlying bone. Isometric exercises should be preformed _____ while the patient is awake
hourly
33
quadriceps setting exercise
·position pt supine with leg extended
·instruct pt to push knee back onto the mattress by contracting the anterior thigh muscles
·encourage pt to hold the position for 5 to 10 secs
·let pt relax
·have pt repeat the exercise 10 times each hour when awake
34
gluteal setting exercise
·position pt supine with legs extended
·instruct pt to contract the muscles of the buttocks
·encourage the pt to hold the contraction for 5 to 10 secs
·let the pt relax
·have pt repeat exercise 10 times each hour awake
35
complications with a cast splint or brace to report to primary care provider:
```
uncontrolled swelling and pain
cool pale fingers or toes
paresthesia
paralysis
purulent drainage staining cast
signs of systemic infection
cast splint or brace breaks
```
36
to control _____ the immobilized arm is elevated above heart level with a pillow. When the pt is lying down the arm is elevated so that each joint is positioned higher than the preceeding proximal joint (elbow higher than shoulder hand higher than elbow)
swelling
37
Volkmann's ischemic contracture
rare but potentially devastating ischemic necrosis of the forearm muscles
38
circulatory disturbances in the hand may become apparent with signs of cyanosis, swelling and an inability to move the fingers. A missed compartment syndrome in the arm can result in a _____ ischemic contracture which may lead to devastating impairement of motor function and sensibility. Contracture of the fingers and wrist occurs as the result of obstructed arterial blood flow to the forearm and hand. The pt is unable to extend the fingers, describes abnormal sensation (unrelenting pain, pain on passive stretch) and exhibits signs of diminished circulation to the hand
volkmanns
39
the pt leg must be supported on pillows to the level of the heart to control swelling. Cold therapy or ice packs should be applied as prescribed over the fracture site for _____ to _____ days. The pt is taught to elevate the immobilized leg when seated. The pt should also resume a recumbent position several times a day with the immobilized leg elevated to promote venous return and control swelling. Gentle toe and ankle exercises that allow for isometric contraction of muscles beneath the cast have also been shown to increase venous return and deminish edema
1-2
40
the nurse assesses circulation by observing the color, temp. and capillary refill of the exposed toes. Nerve function is assessed by observing the pt ability to move the toes and by asking about the sensations in the foot. Numbness, tingling, and burning may indicate _____ nerve injury resulting from pressure at the head of the _____
peroneal fibula
41
injury to the peroneal nerve as a result of pressure is a cause of _____ (the inability to maintain the foot in a normally flexed position) Consequently the pt drags the foot when ambulating
footdrop
42
when the pt exhibits an acute anxiety reaction characterized by behavioral changes and autonomic responses (increased respiratory rate, diaphoresis, dilated pupils, increased heart rate, elevated blood pressure)
cast syndrome
43
_____ _____ _____ syndrome is the physiologic manifestation associated with immobilization from a body cast. With decreased physical activity, gastrointestinal motility decreases and intestinal gases accumulate. The pt exhibits abdominal distention and discomfort, nausea and vomiting, leading to food aversion, poor intake, and weight loss. This may eventually lead to increased abdominal pressure and ileus
superior mesenteric artery
44
the nurse monitors the pt in a large body cast for potential physiologic cast syndrome, noting bowel sounds every _____ to _____ hours, and reports abdominal discomfort and distention, nausea, and vomiting to the primary provider
4-8
45
What are external fixators used for
used to manage fractures with soft tissue damage. Complicated fractures of the humerus, forearm, femur, tibia and pelvis are managed with external skeletal fixators. They are also used to correct defects, treat nonunion, and lengthen limbs
46
after the external fixator is applied, the extremity is elevated to the level of the heart to reduce swelling if appropriate. Any sharp points on the fixator or pins are covered with caps to prevent device induced injuries. The nurse must be alert for potential problems caused by pressure from the device on the skin, nerves or blood vessels and for the development of compartment syndrome. The nurse monitors the neurovascular status of the extremity every _____ to _____ hours and promptly reports changes to the primary provider. Because the pins are inserted externally particular attention is focised on the pin sites for signs of inflammation and infection. The end goal is to avoid ________
2-4
osteomyelitis
47
the nurse assesses each pin site at least every _____ to _____ hours for redness, swelling, pain around the pin sites, warmth, and purulent drainage, because these are the most common indicators of pin site infections. In the first 48 to 72 hours postinsertion, some serous drainage, skin warmth, and mild redness at the pin sites is expected; these are expected to subside after 72 hours
8-12
48
currently there is no consensus or researched based evidence to direct the best method for cleansing and dressing percutaneois pin sites to minimize infection rates and complications. In the absence of such research, aseptic technique during pin insertion is advised, along with general strategies such as cleansing each pin site seperately to avoid cross contamination with nonshedding material (gauze, cotton tipped swab) and using chlorhexidine 2mg/ml solution once _____
weekly
49
if signs of infection are present or if the pins or clamps seem loose, the nurse notifies the _____ _____
primary provider
50
the nurse never adjusts the clamps on the external fixator frame. It is the _____ _____ responsibility to do so
primary providers
51
What is Ilizarov Fixation?
a specialized type of external fixator consisting of numerous wires that penetrate the limb and are attached to a circular metal frame. This device is used to correct angulation and rotational defects, to treat nonunion (failure of bone fragments to heal) and to lengthen limbs. The device gently pulls apart the cortex of the bone and stimulates new growth through daily adjustment of the telescoping rods
52
Traction uses..
a pulling force to promote and maintain alignment to an injured part of the body.
53
The goals of traction include
decreasing muscle spasms and pain, realignment of bone fractures, and correcting or preventing deformities
54
At times traction needs to be applied in more than one direction to achieve the desired line of pull. When this is done, one of the lines of pull counteracts the other. These lines of pull are known as the _____ _____ _____.
vectors of force
55
complications of traction to report promptly to the primary provider
```
uncontrolled swelling and pain
cool pale fingers or toes
paresthesia
paralysis
purulent drainage
signs of systemic infection
loose fixator pins or clamps
```
56
when caring for the pt in traction the nurse should follow these additional principles:
·traction must be continuois to be effective in reducing and immobilizing fractures
·skeletal traction is never interrupted
·weights are not removed unless intermitten traction is prescribed
·any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated
·the pt must be in good body alignment in the center of the bed when traction is applied
·weights must hang freely and not rest on the bed or floor
·knots in the rope or the footplate must not touch the pulley or the foot of the bed
57
_____ traction may be prescribed for short term use to stabalize a fractured leg, control muscle spasms, and immobilize an area before surgery
Skin
58
no more than 2 to 3.5 kg (4.5 to 8 lbs) can be used on an _____
extremity
59
_____ traction is usually limited to 4.5 to 9 kg (10 to 20 lbs) depending on the weight of the pt
pelvic
60
_____ extension traction (unilateral or bilateral) is skin traction to the lower leg.
bucks
61
_____ traction is used as a temporary measure to overcome muscle spasms and promote immobilization of hip fractures in adult patients waiting for more difinitive treatment such as surgery. However current data show no direct benefit to using this traction with pts with hip fractures
bucks
62
to apply bucks traction: the extremity is elevated and supported under the pts heel and knee while the foam boot is placed under the leg, the Velcro straps are secured around the leg - tape that is overwrapped with an elastic bandage in a spiral fashion may be used instead of the boot- excessive pressure is avoided over the _____ and proximal _____ during application to prevent pressure ulcers and nerve damage. The rope is affixed to the spreader or foot plate over a pulley fastened to the end of the bed and attaches the prescribed weight- usually 5 to 8 lbs- to the rope. The weight should hang freely not touching the bed or the floor as this compromises the efficiency of the traction system
malleous
Fibulla
63
the nurse also inspects the skin area that is in contact with tape, foam or shearing forces, at least every _____ hours, for signs of irritation or inflammation
eight
64
the nurse preforms the following procedures to monitor and prevent skin breakdown:
·removes the foam boots to inspect the skin, the ankle and the achilles tendon 3 times a day. A second person is needed to support the extremity during inspection and skin care
·palpates the area of the traction tapes daily to detect underlying tenderness
·provides frequent repositioning to alleviate pressure and discomfort, bc the pt who must remain in a supine position is at increased risk for development of a pressure ulcer
·uses advanced static mattresses or overlays rather than standard hospital foam or alternating-air/low-air-loss mattresses to reduce the risk of pressure ulcer formation
65
care must be taken to avoid pressure on the ____ nerve at the point at which it passes around the neck of the fibula just below the knee when traction is applied to the lower extremity. Pressure at this point can cause foot drop.
peroneal
66
_____ of the foot demonstrates function of the peroneal nerve
dorsiflexion
67
weakness of dorsiflexion or foot movement and _____ of the foot might indicate pressure on the peroneal nerve
inversion
68
_____ flexion demonstrates function of the tibial nerve
plantar
69
after skin traction is applied the nurse assesses circulation of the foot within _____ to _____ minutes and then every _____ to _____ hours
15-30
1-2
70
circulatory assessment consists of:
·peripheral pulses, color, capillary refill, and temp of the fingers and toes
·manifestations of deep vein thrombosis, which include unilateral calf tenderness, warmth, redness and swelling
71
the nurse encourages the pt to preform active foot exercises every _____ when awake
hour
72
_____ traction is often used when continuous traction is desired to immobilize, position, and align a fracture of the femur, tibia and cervical spine. It is used when traction is to be maintained for a significant amount of time, when skin traction is not possible, and when greater weight (11 to 18 kg) 25 to 40 lbs is needed to achieve the therapuetic effect
Skeletal
73
what type of traction do you use when 25 to 40 lbs is needed
Skeletal
74
the surgeon applies skeletal traction using _____ asepsis
surigcal
75
in _____ _____ the weights applied initially must overcome the shortening spasms of the affected muscles. As the muscles relax, the traction weight is reduced to prevent fracture dislocation and to promote healing
skeletal traction
76
often skeletal traction is _____ traction, which supports the affected extremity, allows for some pt movement, and facilitates pt independence and nursing care while maintaining effective traction
balanced
77
the _____ splint with a _____ attachment is frequently used with skeletal traction for fractures of the femur. Because upward traction is required an overbed frame is used
thomas pearson
78
the nurse must never remove weights from _____ traction unless a life threatening situation occurs. Removal of the weights defeats their purpose and may result in injury to the pt
skeletal
79
pain must be reported to the _____ _____ if body alignment fails to reduce discomfort of skeletal traction
primary provider
80
to encourage movement without using the elbows or heel a _____ can be suspended overhead within easy reach of the pt
trapeze
81
specific pressure points are assessed for irritation and inflammation at least every _____ hours. Pts at high risk for skin breakdown (older adults, malnourished pts) may need to be assessed more frequently
8
82
areas that are particularly vulnerable to pressure caused by a traction apparatus applied to the _____ extremity include the ischial tuberosity, popliteal space, Achilles tendon and heel.
lower
83
the nurse evaluates the body part to be placed in traction and compares its neurovascular status (color, temp, cap refill, edema, pulses, ability to move and sensations) to the uneffected extremity every hour for the first _____ hours after traction is applied and every _____ hours thereafter
24
4
84
venous thromboembolus (VTE) is a significant risk for the immobilized pt. The nurse encourages the pt to do active flexion extension ankle exercises and isometric contraction of calf muscles (calf pumping exercises) _____ times an _____ while awake to decrease venous stasis
10 hours
85
the nurse must _____ investigate every report of discomfort expressed by the pt in traction. prompt recognition of a developing neurovascular problem is essential so that corrective measures can be instituted quickly
immediately
86
for the first _____ hours after insertion the site is covered with a sterile absorbent nonstick dressing and a rolled gauze or ace type bandage. After this time a loose cover dressing or no dressing is recommended. ( a bandage is necessary if the pt is exposed to airborne dust)
48 hours
87
pins located in areas with soft tissue are at greatest risk for _____
infection
88
after the first 48 to 72 hours following skeletal pin placement pin site care should be performed _____ or _____
daily
weekly
89
for pin site cleaning _____ solution is the most effective cleansing solution. If chlorhexidine is contraindicated (due to known sensitivity or skin reaction) saline solution should be used for cleansing
chlorhexidine
2mg/ml
90
strict _____ before and after skeletal pin site care should always take place
handwashing
91
the nurse must inspect the pin sites every _____ hours for reaction. (normal changes that occur at the pin site after insertion) and infection
8
92
signs of _____ may include redness, warmth, and serosanguineous drainage at the site, which tends to subside after 72 hours. Signs of infection may mirror those of reaction but also include the presence of purulent drainage, pin loosening, tenting of skin at pin site, odor and fever.
reaction
93
_____ related complications may include pressure ulcers, atelectasis, pneumonia, constipation, loss of appetite, urinary stasis, urinary tract infections and VTE formation
immobility
94
the nurse auscultates the pts lungs every _____ to _____ hours to assess respiratory status and educated the pt about performing deep breathing and coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions
4-8
95
the nurse educates the pt about how to perform ankle and foot exercises within the limits of the traction therapy every _____ to _____ hours when awake to prevent DVT
1-2
96
in general surgery should be performed _____ surrounding muscles become contracted and atrophied and serious structural abnormalities occur
before
97
acute postoperative anemia due to perioperative blood loss frequently occurs in pts undergoing total joint replacement and has been found to occur in up to _____ of pts who had routine total hip and knee arthroplasties
50%
98
a blood loss of up to _____ during the procedure may be anticipated; therefore several units of blood should be available. Because most orthopedic surgeries are elective many pts may donate their own blood during the weeks preceeding their surgery
1500 ml
99
allogeneic blood
donor blood
100
self blood name?
autologous blood
101
one approach to minimize blood loss during orthopedic limb surgery (total knee arthroplasty TKA) is the application of a pneumatic _____
tourniquet
102
intraoperative _____ _____ _____ salvage with reinfusion is used when a large volume of blood loss is anticipated
red blood cell
103
a promising intervention to decrease total blood loss and reduce the need for allogeneic blood transfusions without an increase in surgical complications is the administration of intraoperative thrombolytics such as _____ _____ TXA
tranexamic acid
104
if a pt is at risk for postoperative bleeding or is _____, epoetin Alfa (epogen, procrit) or iron supplements (ferrous sulfate) may be prescribed preoperatively to increase hemoglobin
anemic
105
increasing age (older than 40), obesity, taking prescription _____ medication, preoperative leg edema, previous history of any VTE, and vericose veins increase the risk for postoperative DVT and PE
hormonal
106
the use of medications that increase the risk of clotting, such as certain hormones and NSAIDS, may be discontinued a _____ before surgery
week
107
any infection presenting _____ to _____ weeks before planned surgery may result in postponement of surgery
2-4
108
research findings suggest that prophylactic broad spectrum antibiotics given _____ minutes prior to skin incision and discontinued within 24 hours postoperatively are effective in preventing surgical site infections. If antibiotics are given too early (60 or more minutes before surgery) the pts risk of infection may increase
60
109
an important consideration in total knee replacements is that the antibiotic should ideally be infused _____ minutes prior to tourniquet inflation
10
110
all _____ adult pts post THA should be placed on a higher specification foam pressure relieving mattress rather than a standard hospital mattress
older
111
a major goal following surgery for an older pt is early mobilization in an effort to prevent the complications associated with prolonged immobility and to return the pt to functional activity. Early assisted mobilization and ambulation on the _____ _____ surgery can decrease hospital length of stay, complications, and hospital costs and can prepare pts to care for themselves at home with a higher level of independent functioning
day of
112
the risk for dislocation is more common with this approach and may occur when the hip is in full flexion, adducted (legs together), and _____ rotated
adducted internally
113
the pt should be in a supone position with their head slightly elevated and the effected leg in a neutral position. The use of an abduction splint, a wedge pillow, or 2 or 3 pillows placed between the legs prevent adduction beyond the midline of the body. A cradle boot may be used to prevent leg rotation and to support the heel off the bed preventing development of a pressure ulcer. When the nurse turns the pt in bed to the unaffected side it is important to keep the operative hip in _____. The pt should not be turned to the operative side which could cause dislocation unless specified by the surgeon
abduction
114
the pts hip is never flexed more than _____ degrees. When using a fracture bedpan the nurse instructs the pt to flex the unaffected hip and to use the trapeze to lift the pelvis onto the pan . The pt is also reminded not to flex the affected hip.
90
115
limited flexion is maintained during transfers and when sitting. when the pt is initially assisted out of bed an abduction splint or pillows are kept between the legs. The nurse encourages the pt to keep the effected hip in extension, instructing the pt to pivot on the unaffected leg with assistance by the nurse who protects the affected hip from _____ , flexion, internal or external rotation and excessive weight bearing
adduction
116
high seat chairs with arm rests, and raised toilet seats are used to minimize hip joint flexion. When sitting the pts hips should be _____ than the knees. The pts affected leg should not be elevated when sitting. The pt may flex the knee.
higher
117
the nurse educates the pt about protective positioning which includes maintaining abduction and avoiding internal and external rotation, hyperextension and acute flexion. At no time should the pt cross their legs or bend at the waist past _____ degrees
90
118
hip precautions for pts who had a posterior or posterolateral approach for THA should be enforced for _____ months or longer after surgery. A pt who has had an anterior surgical approach may not need these precautions
4
119
changes in pulse, blood pressure, and respirations may indicate development of _____
shock
120
within 48 hours bloody drainage collected in portable suction device should decrease to _____ to _____ ml per 8 hours. Excessive drainage (_____ _____ _____ ml in first 8 hours after surgery) and bright red drainage may indicate active bleeding
25-30
more than 250
121
hip is never flexed more than _____ degrees to prevent dislocation
90
122
diminished pain and sensory functioning may indicate nerve damage. Sensation in web between great and second toe = _____ nerve.... sensation on sole of foot = _____ nerve
peroneal tibial
123
dorsiflextion of ankle and extension of toes indicate function of _____ nerve
peroneal
124
plantar flexion of ankle
and
flexion of toes indicate function of _____ nerve
tibial
125
12-20 breaths per minute
12-20 breaths per mintue
126
assess for dislocation of prosthesis
·extremity shortens
·internally or externally rotated
·severe hip pain
·unable to move extremity
127
for DVT remove stocking for _____ minutes twice a day and provide skin care
20
128
for DVT assess for unilateral calf pain or tenderness every _____ hours
8
129
for DVT supervise ankle exercises _____
hourly
130
s+s of dislocaton of prosthesis for hip arthroplasty that must be reported to the surgeon immediately
·increased pain at the surgical site, swelling and immobilization
·acute groin pain in the affected hip or increased discomfort
·shortening of the affected extremity
·abnormal external or internal rotation of the affected extremity
·restricted ability or inability to move the leg
·reported popping sensation in the hip
131
stresses to the new hip joint should be avoided for the first _____ to _____ weeks when the risk of dislocation is greatest
8-12
132
the risk of dislocation in hip arthroplasty is greatest within the first _____ to _____ weeks
8-12
133
with hip arthroplasty patients begin ambulation with the assistance of a walker or crutches within a _____ after surgery
day
134
in hip arthroplasty the nurse notes the following methods for avoiding displacement
·keep the knees apart at all times
·put a pillow between the legs when sleeping
·never cross the legs when seated
·avoid bending forward when seated in a chair
·avoid bending forward to pick up an object on the floor
·use a high seated chair and a raised toilet seat
·do not flex the hip to put on clothes or shoes
135
if a wound drainage system is used in hip arthroplasty; drainage of _____ to _____ml in the first 24 hours is expected; by 48 hours postoperatively, the total drainage in 8 hours usually decreases to _____ml or less, and the suction device is then removed. Drains that remain in place for longer than 24 hours are at increased risk for contamination and infection may occur.
200-500
30
136
in the absence of prophylactic therapy, which includes mechanical (intermitten compression devices) and pharmacologic prophylaxis (anticoagulant medications for at least _____ days) the risk of post operative VTE is particularly high after orthopedic surgery
10
137
without prophylaxis DVT formation can develop within _____ to _____ days following surgery and can lead to PE which can be fatal
7-14
138
physical signs of ____ include pain and tenderness at or below the area of the clot, swelling or tightness of the affected leg, possibly with pitting edema, with either warmth or coolness, and skin discoloration
DVT
139
_____ symptoms may include acute onset of dyspnea, tachycardia, confusion, and pleuritic chest pain
PE
140
patients should be instructed to dorsi and plantar flex the ankles and toes ____ to ____ times every ____ ____ while awake
10 - 20
Half Hour
141
the use of aspirin, LMWH (lovenox), delteparin (fragmin), and synthetic pentasaccharides are recommended as prophylaxis for VTE should continue for up to _____ days following surgery
35
142
infection- a serious complication of THA- may necessitate removal of the prosthesis. Pts who are older, obese, poorly nourished, smoke cigarettes, or use corticosteroid medications (prednisone) and pts who have diabetes, rheumatoid arthritis, concurrent infections (urinary tract infection, dental abscess) carry MRSA, or have hematomas are at high risk for infection
Infection
143
1 in _____ patients with THA will undergo revision of the prosthesis, most commonly because of aseptic loosening, infection, instability, or a mechanical complication
5
