Orthopedic Nursing Flashcards
(255 cards)
1
Q
total bones in adult
A
206 bones
2
Q
total bones in newborn
A
270 bones
3
Q
breast plate
A
sternum
3
Q
collarbone
A
clavicle
4
Q
5 Flat bones
A
-sternum
-clavicle
-scapula
-skull
-pelvis
5
Q
shoulder blade
A
scapula
6
Q
lateral curvature of the spine
A
Scoliosis
7
Q
common in female teenagers (screening ageg)
A
Scoliosis
8
Q
confirmatory test for Scoliosis
A
X-Ray
9
Q
Priority in patients with Scoliosis
A
Pulmonary Impingement (breathing)
10
Q
test for Scoliosis when the patient’s body is lateral to the floor to determine if scapula is elevated and a/symmetrical
A
Adam’s Forward Bend Test
11
Q
Main reason why the bones decrease as the age increases
A
Fusion of the bones
12
Q
2 Management for Scoliosis
A
Milwaukee Brace
Harrington Rod Insertion
13
Q
How many years is Milwaukee brace worn?
A
3 years
13
Q
How many hours is Milwaukee brace worn?
A
23 hours
1 hour - hygiene and swimming
14
Q
What is the priority on patients with Milwaukee Brace?
A
Prevent Skin Breakdown
15
Q
Is it allowed to put lotions and creams to the skin of a patient with Milwaukee brace?
A
Do not apply anything on skin unless until prescribed!
-Brace not direct contact on skin
16
Q
management for Scoliosis to lessen curvature and muscle spasms
A
Milwaukee Brace
17
Q
Regions of the Spine
A
CTLSC
Cervical
Thoracic
Lumbar
Sacral
Coccyx
18
Q
Posterior thoracic curvature of the spine
A
Kyphosis
[kpt]
19
Q
curvature of the spine common in elderly
A
Kyphosis
20
Q
curvature of the spine common in pregnant
A
Lordosis
21
Q
Slip Disc
A
Herniated Nucleus Pulposus
21
Q
anterior lumbar curvature of the spine
A
Lordosis
[lal]
21
Long Bones
Humerus, Radius, Ulna
Femur, Tibia, Fibula
22
long bones in the lower extremity
Femur, Tibia, Fibula
23
long bones in the upper extremity
Humerus, Radius, Ulna
24
4 Most Common Joints
Shoulder, Elbows, Hips, Knees
25
2 Ball and Socket Joint
Glenoid process
Acetabulum
26
Socket where humerus is connected
Glenoid process
26
Socket in pelvic girdle where femur is connected
Acetabulum
26
Elbows and Knees are which type of joints?
Hinge Joints
27
Shoulder and Hips are which type of joints?
Ball and Socket Joints
27
Joints that can only do flexion and extension
Hinge Joints
(elbows, knees)
28
Joints that can do range of motion, adduction/abduction, etc.?
Ball and Socket Joints
(Shoulder and Hips)
29
to fit or measure the length of the assistive device
Greater Trochanter
30
Bones that contain YELLOW MARROW
Long Bones
31
handle of the assistive device must be at the level of________, ______flexion.
Greater Trochanter,
20-30degree flexion
32
Priority when flat bones are affected
Flat bones: Bleeding
(red marrow)
32
Bones that contain RED MARROW that produces RBCs
Flat bones
33
Priority when long bones are affected
Long bones: Respiratory/Breathing
(yellow marrow consist of fats that may cause pulmonary embolism)
34
most common fracture in elderly
Hip Fracture
35
ball and socket away from center
Abduction
"aBukaka"
35
Why is there a need to promote extension of extremity?
To prevent contractures or fixation of joints (dikit)
35
ball and socket towards the center
Adduction
"aDikit"
35
Best position for Hip Fracture to prevent dislocation of joints
Abduction / Place pillows
36
Patient with Hip fracture:
____mattress
____toilet seat
-firm mattress
-high toilet seat
37
type of bed and position for patient with Hip Contractures
Soft Bed
Prone before sleep
(to promote extension)
38
Best position
Abduction and Extension
39
where is weight given when using crutches
hands or arms
39
how many inches shall be the placement of axillary bar of the crutch in relation to the axilla
2-3 inches below axilla
40
What is the complication common in crutches?
Crutch Paralysis /
Brachial Plexus Paralysis
41
Best site for bone marrow aspiration
Posterior ileac crest
42
Secondary best site for bone marrow aspiration
Anterior ileac crest
43
site of bone marrow aspiration for 1 year old
Tibia
44
connects the bones to muscles
Tendons
45
connects the bone to bone
Ligaments
45
damage of tendons
sTrain
46
damage of ligaments
sprain
47
white, avascular tissue that covers the bones
cartilage
48
damage of cartilage
Osteoarthritis
49
damage of bones
Fractures
49
Common Injury Management
PRICE
"Splint"
X HARM
49
PRICE
Protect
Rest
Ice
Elevate
50
X HARM
No:
Heat Application / Warm Compress
Alcohol
Running Activity
Massage
51
TO PROTECT affected upper extremities
Sling
52
TO PROTECT affected lower extremities
Crutches
52
Rest the affected extremity
(not so restrictive)
Purpose: promote HEALING
Relative Rest
52
used to support and immobilize, and promote extension
Splinting
such as when coughing, or IV insertion site
53
Complication of Bed Rest
Immobility
53
How to prevent pressure ulcers or bedsores
turn the patient every 2 hours
54
How to prevent Deep Vein Thrombosis
wear elastic compression stockings
54
Management for Deep Vein Thrombosis
(+) Homan's sign
NEVER Massage
Refer to the Doctor!
55
Drug of Choice for Deep Vein Thrombosis
Heparin
55
Management for Contractures (flexor)
Range of Motion (ROM)
55
Management for Boredom
Give Cellphone
55
How to prevent pneumonia
Coughing and Deep breathing
56
When the calcium cannot enter the bones leading to what electrolyte imbalance and disease condition
Hypercalcemia
Osteoporosis
56
Nursing management for Osteoporosis
Increase OFI (can have renal calculi)
Turn every 2 hours
57
Indication for Ice
-Swell (shrinks tissue)
-Pain (numbness)
-Prevent bleeding (vasoconstrict)
58
bleeding in the VEIN
Apply Direct Pressure on wound
58
(+) Internal Bleeding
ELEVATE!!!
DO NOT give ice.
(Can coagulate blood)
59
bleeding in the ARTERY
Apply Tourniquet before the wound ;
If possible, cauterize
60
Nursing Management for Hemophilia
Elevate
61
Do NOT apply HEAT / WARM COMPRESS if:
1.
2.
3.
[BSI]
1. Bleeding tendencies
(e.g. may cause rupture)
2. Swelling (bc further swell)
3. Infection (bc further spread)
62
Indication for Elastic Bandage
For Swelling
(more effective than ice)
62
Nursing Management for Hemarthrosis
Elevate
62
Indication for Elevate
For Edema
(promote venous return)
63
Dysmenorrhea management
Can apply heat/warm compress
63
Management for Pain
Heat application / Warm Compress
64
Alcohol can ____ healing process
delay
64
demineralization of the bone
Osteoporosis
65
2 hormones that helps in calcium regulation
Calcitonin , Estrogen
65
common in menopausal women
Osteoporosis
66
Normal Calcium Level
8.6 -10 mg/dL
4.5 - 5.5 meq/L
66
Fracture that is caused by underlying disorder
Pathological fracture
67
Needed for Calcium absorption
Vitamin D
68
Best site for Calcium Absorption
Ileum
69
3 needed for Calcium Metabolism
Calcitonin, Estrogen, Exercise
70
hormone produced by the parathyroid gland that releases calcium by bones into the bloodstream
Parathormone
↑ calcium levels
71
hormone produced by the thyroid gland that lowers calcium levels in the blood (not in the bones).
Calcitonin
↓calcium levels
72
responsible for bone resorption where bone tissues are broken down and calcium will go into the circulation
Osteoclasts
72
2 manifestations of Hypercalcemia
Osteoporosis
Renal Calculi
72
responsible for production of new bone tissue that allows calcium to go into the bones
Osteoblasts
b= Build
73
most common CAUSE of Hypercalcemia
Bed Rest
74
cheek twitching seen in pts with Hypocalcemia
Chvostek Sign
74
most dangerous complication of Hypocalcemia
laryngeal spasm (closure of larynx)
--> respiratory occlusion/arrest
74
sign of Hypercalcemia
Signs related to kidney (e.g. low back pain)
-so need to increase OFI
75
carpopedal spasm seen in pts with Hypocalcemia
Trousseau's Sign
(more definitive)
75
2 MAIN CAUSES OF HYPOCALCEMIA
1. Post Thyroidectomy
2. Renal Failure
76
DOC for Post Thyroidectomy
Calcium Gluconate
76
DOC for Renal Failure
Amphojel
(antacid with phosphate binder properties)
76
which is more dangerous
Hypocalcemia vs Osteoporosis
Hypocalcemia
-so calcium in BLOOD is more important than going into bones
76
Best sources of Calcium
Sardines and Dairy Products (milk, cheese, yogurt, ice cream)
77
Which is better source of calcium: sardines or dairy products
Sardines
78
BQ TIP:
Things to consider upon choosing the best Diet (Philippine setting)
1. LOWER PRICE
2. AVAILABILITY (Luzon - Mindanao)
79
Best source of vitamin D
Food (tuna, mackarel, salmon)
80
Activates vitamin D synthesis
Sunlight
81
where is activated vitamin D stored?
Kidney
82
How to prevent Osteoporosis
[HOW]
Hormonal Replacement of Estrogen
Oral Calcium & Vitamin D intake should be increased
Weight bearing exercises (walking, dancing jogging)
83
Drug of Choice for Osteoporosis
Alendronate (Fosamax)
-inhibits resorption of Ca (calcium will not be released from bones)
84
more rare but severe deficiency in Vitamin D
Softening of bones associated with bone pain
Osteomalacia
85
Nursing management for Osteomalacia
Bed rest
86
the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency
Rickets
87
Parathormone : Calcium
Directly Proportional
↑Parathormone : ↑Calcium
88
Phosphorus : Calcium
Inversely Proportional
↓Phosphorus: ↑Calcium
89
Hyperparathyroidism:
Hypercalcemia
90
2 manifestations of Hyperparathyroidism
Hyperparathyroidism: Hypercalcemia
-Osteoporosis
-Renal Calculi
90
Hypophosphatemia:
Hypercalcemia
91
91
92
93
94
Hyperphosphatemia:
Hypocalcemia
95
inflammation of joints
Arthritis
95
which is more dangerous, Hyperphosphatemia or Hypophosphatemia?
Hyperphosphatemia
-because it also equates to Hypocalcemia (which is more dangerous)
95
95
95
autoimmune arthritis
Rheumatoid Arthritis
95
degenerative type of arthritis
Osteoarthritis
95
metabolic (food) arthritis
Gouty Arthritis
96
causative pathogen of Rheumatoid Arthritis
Epstein Barr Virus
96
common in females children
Rheumatoid Arthritis
97
Inflammation of Synovial Fluids
Rheumatoid Arthritis
98
classic sign of Rheumatoid Arthritis
Morning Stiffness
98
Worsen with rest
Rheumatoid Arthritis
99
normal characteristic of Synovial Fluid
clear
100
confirmatory diagnostic tool for Rheumatoid Arthritis
Arthrocentesis:
(+) cloudy synovial fluid
101
known as moveable joints
Synovial joints
101
Blood test results for Rheumatoid Arthritis
(+) Rheumatoid Factor: Multiple Joint Affected
(+) Anti-nuclear Antibodies (ANA): Autoimmune
(-) Anti-nuclear Antibodies (ANA): Not autoimmune, Epstein Barr
↑ ESR: Severity
102
early sign of nerve compression
(+) Pain
102
later sign of nerve compression
Numbness
103
best management for autoimmune RA
Steroids
104
best management for virus-causing RA
(virus is self-limiting)
- Increase OFI
- Adequate rest
- Vitamin C
105
best management for bacteria-causing RA
Antibiotic
106
which is more dangerous RA ---cause is viral or bacteria?
Bacteria because virus is self-limiting
107
symmetrical (bilateral), systemic
Rheumatoid Arthritis
108
dryness in eyes, buccal mucosa, and vagina
seen in patients with RA
Sjogren's Syndrome
109
anemia, leukopenia, thrombocytopenia, and splenomegaly
seen in patients with RA
Felty's Syndrome
110
late sign of anemia
pallor
110
normal RBC count
RBC : 4-6 million/microliter
111
normal WBC count
WBC: 4,000-11,000
111
management for anemia
REST
112
Low WBC
Leucopenia
112
classic sign of anemia
fatigue
113
Low RBC
Anemia
114
Nursing diagnosis for Leucopenia [RA]
Risk for infection
- no fever
115
Management if:
Fever
↑WBC
(+) infection
REFER!
115
Management for Leucopenia
Avoid crowded places
Avoid fresh food
Avoid raw food
116
Low platelets
Thrombocytopenia
117
Nursing diagnosis for Thrombocytopenia
Risk for bleeding
118
Signs of Bleeding
-bruising
-ecchymosis
-hematoma
-petechiae
119
relieve constipation and avoids valsalva maneuver
stool softeners (e.g. Dulcolax)
120
Management for Thrombocytopenia
Avoid intrusive/invasive procedures
Avoid contact sports
Avoid Valsalva maneuver
Stool Softener
121
normal platelet count
Platelet: 150,000 - 450,000 cells/microliter
122
management for constipation
1. Increase fiber
2. Increase oral fluid intake
3. laxative
x Enema - bowel preparation
122
enlargement of the spleen
Splenomegaly
123
[RA Deformity]
thickening of synovial fluid
Pannus Formation
123
[RA Deformity]
fixation of joints
Bony Ankylosis
124
fingers are bent abnormally - deformity in RA
Swan's Neck
125
hyperextension of the thumb - deformity in RA
Boutonniere
125
Ulnar Deviation
Ulnar Deviation: Upper in
Normal ulna: upper out
126
Ulna
Upper In
126
UTIN
Ulna, Tibia: IN
Radial, Fibula: OUT
127
Tibia
Lower In
128
Fibula
Lower Out
128
Radial
Upper Out
129
Aspirin is contraindicated to ___________
Rheumatoid Arthritis
130
immunosuppressant and anti-inflammatory drug used in patients with RA
Steroids
131
could be long term effect of taking steroids for RA
-Edema (+aldosterone)
-Hyperglycemia (+ cortisol)
-Infection (↓immune system)
132
anti-inflammatory drug used in patients with RA
NSAIDs
133
side effect of NSAIDs
GI irritation
134
when to take NSAIDs
give with meals
(bc can cause GI irritation)
135
Effect of Aspirin if given to patients with RA
-Thrombocytopenia
-Reyes' Syndrome
(serious condition that causes swelling in the liver and brain)
135
More potent the drug, _______
more risky adverse reactions
136
drug for RA that can lessen the progression of RA and can avoid deformity
DMARDS (Disease Modifying Anti-Rheumatoid Drugs)
137
Swan's neck
Boutonniere
Rheumatoid Arthritis
137
drug for RA that can lessen the flare ups (sudden swelling)
Chloroquine
138
drug for RA that is a COX-2 Inhibitor that is LESSER GI irritant.
Contraindicated to pt with cardiac disease.
Celecoxib
138
GOLD STANDARD drug for Rheumatoid Arthritis
Methotrexate (antimetabolites)
-have adverse reactions so give last
-kill normal cells
-hepatotoxic
138
signs of Hepatotoxicity
Nausea and vomiting (earliest)
RUQ pain
Jaundice with pruritus
139
drug to lessen the side effects of Methotrexate
Leucovorin
140
Management for (+) pruritus [bilirubin on skin] due to hepatotoxicity of Methotrexate
-Cold compress
-Increase OFI
140
wear and tear of weight bearing joints
Osteoarthritis
- joint disorder, not bone!
140
degeneration of cartilage
-(non-inflammatory)
Osteoarthritis
141
Diagnostic test for Osteoarthritis
X-Ray:
-narrowing of the joint spaces
-osteophytes formation (new bone growth in compensation)
142
common in athletes, hardworking people (overused)
Osteoarthritis
143
localized, asymmetrical
Osteoarthritis
144
most common type of arthritis
Osteoarthritis
145
[Osteoarthritis]
Distal interphalangeal nodes "DIP"
Heberden's Nodes
H: High
145
grating sound on Osteoarthritis
Crepitus
145
[Osteoarthritis]
Proximal interphalangeal nodes "PIP"
Bouchard's Nodes
B:below
146
Worsen with work
-rest until pain subsides
Osteoarthritis
147
common in males and hereditary
Gouty Arthritis
148
abnormal purine metabolism
Gouty Arthritis
149
Asymmetrical, big toe "podagra"
Gouty Arthritis
150
When is gouty arthritis more painful?
at NIGHT!
-Cold: solidification of crystals
150
confirmatory for Gouty Arthritis
Arthrocentesis: presence of joint crystals --> TOPHI
151
[Gouty Arthritis]
_______: food (protein)
Uric acid: blood
Purine
151
Management for Gouty Arthritis
Decrease Purine Diet!!!
Avoid: organ meat, legumes, sardines, anchovies, alcohol, shellfish (crab, shrimp, lobster, seahorse, starfish, prawn)
152
most painful arthritis
Gouty Arthritis
153
acute attack of Gouty Arthritis
5-10 days
154
chalk stone (white) deposits on the joints that affect movement
Tophi
154
inflammation of big toe
Podagra
155
Gout Medications Drug of Choice
Allopurinol: Zyloprim
(anti-gout) -dissolves uric acid
156
3 Gout Medications
1. Allopurinol : Zyloprim
(anti-gout) -dissolves uric acid
2. Benemid : Probenecid
(anti-inflamm) - dissolves crystals/tophi
3. Colchicine : Novocolchine
(during acute attack)
(+) diarrhea: Refer
157
for acute attack of Gouty Arthritis
Colchicine : Novocolchine
(+) diarrhea: Refer
Contraindicated: Allopurinol
158
Neurovascular Assessment
6Ps
Pulselessness
Pallor
Poikilothermia
Pain
Paresthesia
Paralysis
158
nursing intervention for Allopurinol and Benemid
increase fluid intake
to prevent renal stones
158
Traction: ______
pulling
159
Pain on traction
✅Skeletal traction
❌Skin Traction
❌Pin sites
160
When is traction indicated
Prior / before surgery
160
Normal capillary refill
1-2 seconds
161
Pulse Deficit
Apical pulse rate - peripheral pulse rate = pulse deficit
Apical Pulse: 100bpm
Affected periphery: 80 bpm
Pulse Deficit: 20bpm
162
Bad leg (affected) is warmer than good leg (unaffected)
Infection
162
Refer all 6Ps of NVA except:
Pain
163
Principle of Traction:
Foot of the client should not touch the ____
foot of bed
163
distance of crutches
6-10 inches
163
distance of cane
4-6 inches
164
Elderly; Parkinson's
Walker
165
1 foot affected
Crutches
165
2 feet affected
Wheelchair
165
Stroke
with "hypertension"
with "hemiparesis / hemiplegia"
Cane
166
most stable assistive device
walker (4 foot parts)
167
least stable assistive device
Cane (only 1 foot part)
167
How to use walker
Walker
Walk
Walker
Walk
168
How to use Cane
Weakness: Left
Cane: Right
Cane
Lean
Bad leg
Good leg
169
How to Use Crutches Downstairs
Crutches
Bad leg
Good leg
170
How to Use Crutches Upstairs
Good leg
Crutches + Bad leg
170
duration of drying of Fiberglass cast
20-30 minutes
170
duration of drying of Plaster of Paris cast
48-72 hours
171
To which patient shall you give sardines?
a. Osteoporosis
b. Gouty Arthritis
✅Osteoporosis
❌Gouty Arthritis
172
173
174
complete opposite of Osteoporosis
Rheumatoid Arthritis
RA: systemic, symmetrical
OA: localized, asymmetrical
