Orthopedics Flashcards by Fairouzjiwa Jiwa

When someone is in:
Pain/tenderness
Unnatural movement
has a deformity and a shortening of an extremity
has crepitus, swelling and discoloration
These could be s/s of what?

Fracture

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What is the one thing we worry about with a fracture

Compartment syndrome

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How do we treat fractures

Immobilize bone ends plus adjacent joints
Support fracture above and below site
Move extremity as little as possible
Use splints
Cover open fractures with something sterile

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What do splints help with

Prevent fat emboli and muscle spasms

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When performing a neurovascular check, what are you assessing

Pulse
Color
Movement
Sensation
Cap Refill
Temp

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What are some complications related to Fractures?

Shock (hypovolemic)
Fat Embolism
Compartment syndrome

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What kind of fractures do we see shock and fat embolism in

Long bones, femur

Pelvic fractures and crushing injuries

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Petechiae or rash over chest
conjunctival hemorrage
snow storm on cxr
young males 
first 36 hours
What are these s/s related to?

Fat Embolism

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What is compartment syndrome

It is pressure build up in a limited space,

fluid accumulates in the tissues and impairs it.

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What is the main symptom of compartment syndrome

Severe Pain not relieved with pain meds

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What are some common areas that compartment syndrome can occur

Forearm and quadricep

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What can we do to prevent compartment syndrome

Elevate extremity
Soft cast then rigid cast
loosen cast to restore circulation
-cast cutters to remove cast
fasciotomy

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How long do you have ice packs on the side for after putting on a plaster and fiberglass cast for?

24 hours, because plaster still wet

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What do you use to assess while the casting material is still wet

palm of hands

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What should you do for a cast

Keep cast uncovered and allow to air dry
do no rest on a hard/sharp surface
circle bleeding and date and time it
neuro vascular checks
cover cast close to groin

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What cast is more common to use

Fiberglass, it is lighter and stronger and provides early weight bearing

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What do tractions do

Decrease muscle spasm, reduces immobilizes

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Should traction be continuous or intermittent

Continuous

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Should the weights be hanging freely and knots secure

yes

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What should we maintain for the patient

Good positioning, pulled up in bed centered and good alignmet, exercise non-immobilized and special air filled foam mattress

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What are the types of traction

Skin Traction

Skeletal Traction

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what are skin tractions used for

short term relieve of muscle spasm and to immobilize until surgery

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What assessment is important with skin traction

Skin assessment

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What type of traction are

tape, boot, splints, buck

Skin traction

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What are skeletal tractions used for

Prolonged traction, months

How are skeletal tractions used

It is applied to the bone with pins and wires

What are Steinman pins, crutchfield, Gardner-well tons, halo vests examples of

Skeletal traction

What should we be monitoring with skeletal traction

Maintain sterile technique Remove Crusts and Serous drainage is ok

What type of traction is used frequently pre-op of a hip fracture

Buck's traction

What things should a nurse be assessing post-op hip surgery

Neuro vascular checks Monitor drains Assess firm mattress Have an over-head trapeze to build upper strength

What kind of position do you have someone post-op a hip surgery

Neutral position, toes to ceiling Limit flexion, want EXTension of the hip Abduction

What kind of exercise do we encourage post-op hip surgery

Isometric while in bed

What do we use a trochanter roll for post-op hip surgery

To prevent external rotation and document in nurses notes

When should the patient be weight bearing post-op

After ordered by physician

What should you tell the client to not do after a hip surgery

Avoid crossing legs, bending over, don't sleep on operated side until ok by dr. No stress to hip joints in the first 3-6 months HYDRATE

Do we give pain meds to affected hip

What are some complications associated with Total hip replacement

Dislocation Infection Avascular necrosis Immobility problems

When someone has a shortening of leg, abnormal rotation and can't move extremity due to pain what are they showing s/s of

Dislocation

How do we prevent infection for a total hip replacement

Prophylactic antibiotic | and remove foley's and drains asap

What is avascular necrosis

Death of tissues due to poor circulation

What should we teach clients after hip replacement

to walk/swim and avoid flexion

How does someone avoid flexion of the hip

Avoid low chairs, traveling long distance, sitting more than 30 minutes, lifting heavy objects, excessive bending or twisting, stair climbing

What are some things to remember for a Total Knee Replacement

Use CPM (continious passive motion) Keep knee in motion and prevent formation of scar tissue Pain Management

Should the PT set the machine to gradually increase flexion and extension of knees

Yes

Should you hyperextend or hyperflex knees after a total knee replacement

What should you be assessing

Neurovascular checks

For an amputation where does it usually occur and why

Done in the more distal point so that the surgeon can preserve the knee and elbow for prostethes

What do you keep at the bedside post-op of an amputation

Turnoquet

Should you be elevating post-amputation

It's controversial because you could develop contracture, but if you do, elevate bed not use a pillow and only for a short time

How do you prevent contractures of the hip and knee

By extension of the limb, lying flat on the bed

Below the Knee amputation you worry about contractures where?

Hip and Knee

What can you do to prevent contractures on hip and knee

Put patient on stomach

What do you do to decrease phantom pain

Diversional activity/pain management | First diversional, least invasive first

Phantom pain seen more with what kind amputation

Above the knee

When can you expect to see the phantom pain subside

after 3 months

Why is limb shaping important

So you can fit prostehesis

What shape should the stump be shaped at the end

Cone

What is worn under the prosthesis

Limb socks

Why should we strengthen upper body after amputation

So that patient is strong to use crutches or walker

Do you think it is safe to massage a stump and why

Yes, to promote circulation and decrease tenderness

How can one toughen a stump

1) press into soft pillow 2) press into hard pillow 3) Push stump to bed 4) Push stump to chair

With walkers what do you do?

Walk into them

Crutches should be?

1-2 inches below axilla because it could cause brachial nerve damage

Up stairs using crutches

Up with good leg

Down stairs using crutches

Down with bad leg

Canes should be used on what side of the body

Strong side

Orthopedics Flashcards

(66 cards)