Fractures & Joint Replacements Flashcards
(72 cards)
1
Q
What causes a Hip Fracture?
A
- trauma from a fall
2
Q
Types of Hip Fracture
Where does an Intracapsular fracture occur? Provide examples of an Intracapsular fracture.
Where does an Extracapsular fracture occur? Provide e
A
Intracapsular Fracture: Within joint capsule
- femoral head & neck
Extracapsular Fracture: oputside of capsule
- Intertrochanteric (Trochanteric region)
- Subtrochanteric
3
Q
What causes a Collies (Wrist) Fracture?
A
- someone tries to break their fall
-> extend hand outward as they fall
4
Q
What causes a Spinal Fracture?
A
- vertebral compression
5
Q
What are Clinical Manifestation of all Fractures?
A
- Changes in CSM
- Crepitus
- Numbness/Tingling
-> distal portion of extremity - Deformity in affected area
- Swelling/Bruising
- Pain
6
Q
What are diagnotic procedures for all fractures?
A
- Hx & Physical
-
X-Ray
-> confirms if fracture is present
7
Q
What labs and imaging must be done before an operation on a fracture?
A
Labs:
- CBC w/ Lytes
-> needed by anesthesiology - UA
- Clotting Factors (Pt, PTT, INR)
-> assess patients bleeding/coagulation
Imaging:
- EKG
- CXR
8
Q
Brown Bear recently suffereed a hip fracture. What surgery is he going to need? Describe the two types of surgery
A
Hip Arthroplasty
-
Partial Hip Arthroplasty (Hemiarthroplasty)
-> Replace femoral head -
Total Hip Arthroplasty
-> replace Femoral Head & acetabulum
9
Q
BABA the labubu recently suffered a Collies (wrist) fracture. What procedure will BABA have to get dont? Describe the procedure
A
Treatment (done by doctor): closed/manual reduction (cast applied after reduction)
- external manipulation of bone fragments into place (no surgery)
-> requires local anesthetic (Lidocaine)
10
Q
Perfect Teddy, the white teddy lulu, recently suffered a spinal fracture.
What procedure do they need to have? What does it treat?
Describe the procedure.
A
Balloon kyphoplasty: stabilize verterbra compression fracture & pain
- Ballon is inserterd into vertebrae
- Ballon is inflated iside of evrtebrae
- Bone cement is injected to keep balloon inflated
- Bone cemet fills balloon space
- Vertebrae returns to somewhat original/normal shape
11
Q
50% of older adults die within the first year of a hip fracture. What does hip fracture have a high mortality rate?
A
- Surgery
- Depression
- Decreased Mobility
12
Q
Why do patients with both hip and wrist (Colles’) fractures have difficulty using a front-wheeled walker?
A
Inability to bear weight on wrist and on leg of affected hip
13
Q
What equipment modification can help a patient with a hip and wrist fracture use a walker?
A
walker w/ platform (armrest) attachments to support the forearm
14
Q
Why are crutches contraindicated for patients with a Colles’ fracture?
A
Crutches require full upper body strength and weight-bearing through the wrists and hands
15
Q
Describe the following:
Closed (simple) fractures
(Description, Treatment)
A
Description:
- a break or disruption of bone that does not extend through the skin
Treatment:
- Closed manual reduction (for minor fractures)
-> bones put back into place w/o surgery
-> X-Ray: ensure bones are back in place
16
Q
Describe the following:
Open (Compound) Fracture
(Description, Wound Care, Assessment, Treatment)
A
Description:
- a fracture that extends through the skin
Wound Care:
- cover w/ dry sterile dressing
-> pvt bacteria from entering
Assessment:
- Neurovascular Assessment: assess for poor circulation to exretemity
-> 6 P’s
-> CSM
Treatment:
- Open Reduction Internal Fixation (ORIF)
-> Surgical realignment of a fracture with internal hardware
17
Q
Fractural Surgical Repair can cause immobility. What complications can immbolity lead to?
A
- lung Infection/Pneumonia
-> Encourage Spirometry use post-op - VTE and DVT/Pulmonary Embolism
-> blood stasis → blood clot formation → travel to lung - Renal Calculi
- Pressure Ulcers
- Avascular necrosis
- Joint Contractures/Disability
18
Q
What is an intervention to prevent immobility post op from a fracture surgical repair?
A
- Move pt every 2 hours
-> be cautious of bone/joint restrictions
19
Q
What are some preoperative assessments that need to be for a Joint Replacement?
A
Obtain Baseline:
-
I&O
-> Renal Impairment -
Fracture site
-> CSM q2h -
Level of Functioning
-> ID realistic pt goals & success -
Pain
-> effectiveness of meds - ABC
20
Q
What should you make sure the patient nutrition/diet is before their operation?
A
NPO
21
Q
Pre-Operative Joint Replacement
Why should you educate the patient about pre-op/post-op expectactions?
A
help reduce anxiety about the procedure
22
Q
What are post-op assessments that shouls be doen after a Joint Replacement?
A
Baseline:
- I&Os
-
LOC: disorientation r/t anesthesia
-> elder pt disortate r/t trauma, shock, medication, infection -
Compare level of fucntion
-> ID goal progression
-> get as close to previous level
23
Q
What diet should a pt be on post op from a joint replacement?
What should be done prior to feeding a patient?
A
- Clear Liquids (progress slowly)
-> ensure pt is awake & alert prior to feeding
24
Q
What test should be done on a post-op patient? Why?
A
- Nursing Bedside Swallow Test
-> assess swallowing capabilities
25
# Nursing Interverntion Post Op from Joint Replacement
What **sexual and desiease preventative** **educaiton** should be prvoded to a patient who is **post** **op** from a **Joint** **Replacement**?
- **Sexual Activity**
-> use pillows fro stability
-> non-weight bearing position (bottoms)
- **Use Incentive Spirometer**
-> pvt Pneumonia
26
A patietn is currently **post op** after having a **joint replacement surgery**. What **exercise** **education** should be provided to the patient?
**Mobility Limitation**
- leave affected area alone
-> until evaluated by PT for restrictions
- ROM exercise while in bed
27
Who does the intial dressing change after surgery?
Dressing changes should only be don when there is a...?
- Surgeon
Dressing changes should only be don when there is a doctors order
28
A patient is post op from having a joint replacement surgery. How can we prevent the formation of DVT?
short-term **anticoagulants**
- heparin, lovenox
29
Which members of the healthcare team should a patient consult with after their joint replacement? Why?
**PT:** mobility training
- mprove muscles, outcomes, limitations
- learn how to move safely
**OT:** ADL training
- - ex: trigger reacher, sock applicator
30
What type of Joint is being replaced in a **Total Hip Arthroplasty/Replacement**?
ball and socket
31
What postural restrictions are put into place fro a **posterior approch** of a **total hip arthroplasty/replacemet**?
Traditional Hip Precaustions
- No adduction
- No felxion more than 60-90 degrees
- No internal rotation
- Support legs with pillow
32
What postural restrictions are put into place fro a **anterior approch** of a **total hip arthroplasty/replacemet**?
- No extreme abduction
- no hyperextension
- no extreme external rotation
-> no pointing toes outward
-> no crossing legs
33
What **positioning** **precautions** should be taken **after** a **total** **hip** **arthroplasty** (THA)?
- use abduction pillow to pvt bringing legs together to pvt injury post-op
- place pillows between knees when in bed/at tonight for 6-8 weeks
34
When turning a patient who just had a **total** **hip** **arthroplasty**, why do you want to put a pillow in place when **turning** them?
avoid putting pressure on surgical site
35
How should an extremity be **positioned** for **comfort** after a **hip fracture**?
- keep extremity & joint immobilized
- splint in end natural position
36
What **complications** can arise from a **Total Hip Arthroplasty**?
- Atelectasis
- constipation
-> due to immobility & narcotic medication use
- Anemia: bleeding from surgery
- **Foot Drop**
- **Hip Dislocation**
37
What are some clinical manifestations of hip dislocation from a Total Hip Arthroplasty?
- Severe pain
- Shortened limb
- Inability to move/rotate hip
38
T/F: Nurses are able to pop a dislocated hip back into place
FALSE, It is not in a nurses cope of practice. Only doctors can perform relocation of a disloacted hip
39
A paitent just had a **total hip arthroplasty**. What **exercise** **education** should be provided to them?
- **Avoid prolonged knee flexion**
- **Avoid weight bearing restriction**
-> unless evaluated by PT or Surgeon
- Pain meds before OT/PT
- Incentive Spirometry
-> expand/exercise lungs
40
What type of joint is being replaced in a **Total Knee Arthroplasty/Replacement**?
hinge joint
41
What are some **pain** **mangement** methods used after a **total knee arthroplasty**?
- Analgesics
- nerve blcokers
- ice pack
- OnQ pump
-> continuous flow of local anesthetic to surgical site
42
What **drains** are common to see put in place after a **total hip/knee arthroplasty**?
JP drains
43
What type of **equipment** is used after a **total knee arthroplasty**?
- **Knee immobilizer**
-> must be used when out of bed
-> no patellar strap
- **Bulk Splint**s: reduce swelling
-> temporary
-> discontinued by surgeon
44
What com[lpications can come from **total knee arthroplasty** & **total shoulder arthroplasty**?
- Atelectasis
- constipation
-> due to immobility & narcotic medication use
- Anemia: bleeding from surgery
45
Abby recently underwent total knee arthroplasty. What exercise education should be provided to her?
- **Work on Flexion ROM** (Goniometer)
-> at least 0-90 deg
- **Work on Extension** when in bed
-> avoid prolonged knee flexion
-> encourage full extension
-> towel roll under achilles to elevate foot
- Pain meds before OT/PT
- Incentive Spirometry
-> expand/exercise lungs
46
What type of joint is being replaced in a **total shoulder arthoplasty**?
ball & socket
47
What equipment is used after a **total shoulder arthroplasty**?
Shoulder Splint: help shoulder heal properly
- educate/reinforce need to wear
48
what **complications** can arise from a **total shoulder arthorplasty**?
- Atelectasis
- constipation
-> due to immobility & narcotic medication use
- Anemia: bleeding from surgery
49
Matcha Monster recently underwent a **total shoulder arthroplasty**. What **exercise education** should be provided to them?
- Encourage ROM of wrist/fingers
- Rehabilitation w/ OT
-> rotational exercises
-> ADL training
- Pain meds before OT/PT
- Incentive Spirometry
-> expand/exercise lungs
50
For total hip/knee/shoulder arthroplastly, constipation is a possoble risk/complication. How can you prevent constipation?
- Increase fluid/fiber intake
- Be active if possible
- Stool softeners
51
What equipement is used before a hip replacement surgery to reduce muscle spasms? Why are those equipments being used?
- **Buck’s traction**: reduce muslces spasm
-> uncommon
- **Skeletal traction**: Keep bone aligned
- Use blankets and pillows to elevate limbs and relieve pressure on heels
52
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53
Decribe this Device that is is utilized after total joint replacements:
**Front Wheel Walker**
(Function, Joint Replacement Used For, MISC)
**Function:**
- Ambulation
**Joitn Replacement Used For?**
- THA
- TKA
**How to Use:**
- X
**MISC:**
- seen in hospitals
54
Decribe this Device that is is utilized after total joint replacements:
**Elavated Toilet Chair**
(Function, Joint Replacement Used For, MISC)
**Function:**
- prevent flexion
**joint Replacement Used For?**
- THA
- TKA (maybe)
**How to Use:**
- X
**MISC:**
- Risk when rising from sitting
-> use arm bar/rest or ask for assitance
55
Decribe this Device that is is utilized after total joint replacements:
**Trigger Reacher**
(Function, Joint Replacement Used For)
**Function:**
- grab items that are out of reach
-> pvt bending down
**Joitn Replacement Used For?**
- THA
- TKA (maybe)
**How to Use:**
- X
**MISC:**
- X
56
Decribe this Device that is is utilized after total joint replacements:
**Sock Applicator**
(Function, Joint Replacement Used For,How to Use?)
**Function:**
- put on sock without bending 90 deg
**Joitn Replacement Used For?**
- THA
- TKA (maybe)
**How to Use:**
- Place sock in device
- slide foot in wihtout bending
-> bending = pop hip out
**MISC:**
- X
57
Decribe this Device that is is utilized after total joint replacements:
**Shoe Horn**
(Function, Joint Replacement Used For?)
**Function:**
- put shoe on without bending
**Joitn Replacement Used For?**
- THA
- TKA (maybe)
**How to Use:**
- X
**MISC:**
- X
58
Decribe this Device that is is utilized after total joint replacements:
**Shower Chair**
(Function, Joint Replacement Used For?)
**Function:**
- place to sit while they shower/wash
**Joitn Replacement Used For?**
- THA
- TKA
-> TSA maybe
**How to Use:**
- X
**MISC:**
- X
59
Decribe this Device that is is utilized after total joint replacements:
**3-in-1 commode**
(Function, Joint Replacement Used For?)
**Function:**
- elavated device used as:
-> shower chair
-> commode
-> elavated seat for toiler
**Joint Replacement Used For?**
- THA
- TKA
-> TSA maybe
**How to Use:**
- X
**MISC:**
- X
60
Decribe this Device that is is utilized after total joint replacements:
**Cane**
(Function, Joint Replacement Used For?,How to Use?)
**Function:**
- ambulation
**Joint Replacement Used For?**
- THA
- TKA
**How to Use:**
- use on unaffected side
**MISC:**
- X
61
Decribe this Device that is is utilized after total joint replacements:
**Sequential Compression Devices**
(Function, Joint Replacement Used For?, MISC)
**Function:**
- provides intermittent pressure
-> helps with circulation
**Joint Replacement Used For?**
- THA
- TKA
- TSA
**How to Use:**
- X
**MISC:**
- remove BID for 20 minutes
- Need to be worn when ambulating
62
Decribe this Device that is is utilized after total joint replacements:
**Thrombo-Embolic Detterent Stockings**
(Function, Joint Replacement Used For?)
**Function:**
- provides compression
-> pvts DVT
**Joint Replacement Used For?**
- THA
- TKA
-> TSA maybe
**How to Use:**
- X
**MISC:**
- X
63
What are risk factors for falls?
- sensory perception issues
-> hard of hearing/seeing
- altered mental status
-> TIA/Brain Attack
-> **Delirium**
- general weakness
64
What can cause a fall?
- getting up too quickly
- not using assistive devices
65
When do falls typically occur?
- at night
-> poor lighting
-> tiredness
-> nocturia
- at home
- during change of shift report
66
What are some measure that can be taken to **prevent** **falls** from occuring in the **home**?
- adequate lighting/night light
- assess environment
-> non skid flooring @ home
-> tripping hazards
-----> rugs
-----> wires
67
What are some measure that can be taken to prevent falls from occuring in the hospital?
- use bedside commode
- non-skid socks
- side rails
- bed/chair alarms
68
What education should be provided to patient in order to reduce the possibility of a fall?
- assess environment
- be aware of physical limitation
69
Falls are the second leading cause of ____ death. ____ % offalls invole the elderly.
accidental; 75%
70
It is best to encourage independance when patients are performing their ADLS because it helps with ____-______ and ____.
self-confidence; mobility
71
Know examples of types of ADLs & IADLs.
## Footnote
lowk she didnt even go over anything on this slide. she straight up just talk about adls in a general way
refer to master notes
72
What assessment tool can be used to assess fucntional independence in ADLs?
- (P) hysical condition
- (U) pper extremity function
- (L) ower extremity function
- (S) ensory components
- (E) xcretory functions
- (S) upport factors
