Chapter 61: Clients Requiring Orthopedic Treatment Flashcards

1

rigid mold that immobilizes an injured structure while it heals

3 types: cylinder, body cast, hip spica

Cast

2

encircles an arm/leg, leaving the fingers and toes exposed

cylinder cast

3

larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests

body cast

4

surrounds one or both legs and the trunk

strengthened by a bar that spans a casted area b/t the legs
trimmed open in the anal and genital areas to facilitate elimination

spica cast

5

How should a client w/ a spica cast be positioned while the cast dries?

feet are positioned so that they support the desired body alignment and is resting on pillows until the cast dries

6

How are bone fragments kept aligned for clients w/ a cast?

the cast is applied from the joint above the break to the one below it

the joint is slightly flexed to decrease stiffness

7

REVIEW BOX 61-2: APPLYING A CAST

MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST

REVIEW BOX 61-2: APPLYING A CAST

MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST

8

How should a wet cast be kept?

it should be kept uncovered so water can evaporate
drying cast should be supported by pillows
avoid using fingertips and compressing the cast on a hard surface to prevent pressure sores later. Use palm of hands instead

9

may be cut into cast after the cast dries

permits direct inspection of skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing
once this is cut, the solid piece of the cast is replaced in its original site and secured w/ adhesive tape or a roller bandage
leaving this open may allow the skin and soft tissue to bulge through the opening

Cast windows

10

What are some things that may be expected after a cast removal?

What are some interventions to help with what is expected?

Things expected:

skin may appear mottled and may be covered w/ a yellowish crust
this residue may shed for a few days
limb may feel light and client may report weakness/stiffness

Interventions

regarding the skin, the client can soak in a warm bath and use lotions to help soften skin and remove debris
regarding the weakness/stiffness: client's limb will need support
An elastic bandage may be wrapped around the bandage and use a cane or arm sling until progressive active exercise and physical therapy help the client regain normal strength and motion

11

immobilizes and supports an injured body part in a functional position.

used when a musculoskeletal condition:

does not require rigid immobilization
causes a large degree of swelling
requires special skin tx

the healthcare professional fits the client w/a splint and then overwraps it w/ an elastic bandage applied in a spiral mode

this helps promote circulation and maintain the position of the splint

splint

12

provide support, control movement, and prevent additional injury for a more long-term use

custom fit to each client
nurse must provide instruction to the client and family on how to apply the brace and to administer scrupulous skincare to prevent irritation and injury

braces

13

REVIEW NURSING GUIDELINES 61-1

14

A method for pulling structures of the musculoskeletal system

requires countertraction that is usually supplied by the client's own weight
used to relieve muscle spasm, align bones, and maintain immobilization

Traction

skin traction
skeletal traction

15

achieved by applying devices to the skin that indirectly affect the bones or muscles

examples: buck and russell traction

Skin traction

16

REVIEW BOX 61-3: PRINCIPLES OF EFFECTIVE TRACTION

17

REVIEW NURSING GUIDELINES 61-2: MANAGING THE CARE OF THE CLIENT IN TRACTION

18

the bone is restored to its normal position by external manipulation

a bandage, cast, or traction then immobilizes the area
x-rays are taken to ensure correct alignment of the bone

Closed reduction

19

performed in the operating room

the bone is surgically exposed and realigned
x-rays are taken to ensure correct alignment

Open reduction

20

needed to stabilize the reduced fracture

surgeon secures the bone w/ metal screws, plates, rods, nails, or pins
cast or other method of immobilization is then applied

Internal fixation

21

when the surgeon inserts metal pins into the bone or bones from the outside of the skin surface and then attaches a compression device to the pins

External fixation

22

since pin sites are an entry for infection, what should be monitored for?

redness
drainage
tenderness

23

REVIEW NURSING PROCESS FOR THE CLIENT W/ A FRACTURE REDUCTION

24

REVIEW NURSING GUIDELINES 61-3: PROVIDING PIN CARE

25

performed for various reasons:

to correct a deformity
remove a primary bone tumor
align fractured bones (open reduction)
replace or repair a joint
insert a bone graft to promote bone healing
stabilize a bone internally

Orthopedic Surgery

26

total reconstruction or replacement of a joint w/ an artificial joint to restore function and relieve pain

ex. hip and knee surgery

Arthroplasty

27

Post-op complications for clients who've had orthopedic surgery?

hemorrhage
subluxation: dislocation of the joint
infection
thromboembolism
avascular necrosis (death of bone tissue b/c of diminished/absent blood supply)

28

Depending on the type of joint replacement, what may the client be asked to do?

donate their blood preoperatively just in case it has to be used postoperatively if transfusion is required

29

What are very important for clients who have a knee or hip replacement surgery?

early ambulation: goal is to have client bend the knee @ 90 degrees by discharge
anticoagulant therapy

30

Pre-op nursing management care for clients undergoing orthopedic surgery

helping the client to experience reduced pain
continue to be active, mobile, and injury free
practice measures to reduce the potential for post-op infection
control anxiety at manageable levels
understand instructions
comprehend the procedures and rationale of post-op management

31

REVIEW NURSING GUIDELINES 61-4: ENSURING COMPLETE CARE FOR CLIENTS BEFORE ORTHOPEDIC SURGERY

32

Post-op nursing management care for clients undergoing orthopedic surgery

demonstration of deep breathing and coughing and use of a spirometer
withhold aspirin before surgery to reduce risk for excessive bleeding
monitor CBC, prothrombin time, and bleeding and clotting times to ensure that the client's ability to control bleeding is not compromised
review pt's orders concerning turning, movement, position of extremities
head of bed is less than 45 degrees

33

How should a client w/ a total hip replacement be positioned?

have legs abducted w/ pillows or abductor cushion and extended
need to sit in an elevated chair or on a seat raised by pillows so the flexion remains less than 90 degrees
ice packs help to reduce pain and inflammation to the incision site
abduction, neutral rotation, and flexion of less than 90 degrees, NO CROSSED LEGS/CROSSING @ THE FEET

34

REVIEW BOX 61-5: AVOIDING HIP DISLOCATION AFTER CONVENTIONAL REPLACEMENT SURGERY

35

REVIEW TABLE 61-2: PREVENTING POST-OP COMPLICATIONS AFTER JOINT REPLACEMENT SURGERY

36

TRUE OR FALSE?

if a client has pins and screws, they should be sure to let someone know before getting a MRI

TRUE

37

W/i 24-72 hours after orthopedic surgery, what complication may occur? (esp. hip surgery)

S/S include those a pulmonary embolus plus:

petechial hemorrhages on the skin of chest

Fat embolus

38

REVIEW NURSING CARE PLAN 61-1: THE CLIENT UNDERGOING ORTHOPEDIC SURGERY

39

REVIEW CLIENT AND FAMILY TEACHING 61-1: HOME CARE AFTER A LIMB AMPUTATION

40

the removal of a limb that may occur as a result of trauma or in an effort to control disease or disability

lifesaving measure

amputation

41

the end of the residual limb/stump is temporarily open w/ no skin covering it

usually performed in cases of infection
skin traction is applied, and the infected area is allowed to drain
traction is continuous

Open amputation (guillotine method)

42

skin flaps over the severed bone end

return from surgery w/ a soft compression dressing or a rigid plaster shell covering the residual limb

Closed amputation

43

planned when a client has severe infection and gangrene

guillotine method is used first, after infection, a more stable (closed amputation) method is done

Stage amputation

44

Complications post-op amputation?

hemorrhage (keep at tourniquet at bedside)
hematoma
infection
chronic osteomyelitis
stump neuroma: formed when the cut ends of nerves become entangled in the healing scar
phantom pain: body still thinks limb is still there causing burning, tingling, itching, throbbing for the client

45

what are some interventions for phantom pain?

massage the limb

46

Presurgical Nursing management for clients getting amputations?

take complete medical, drug, and allergy hx
evaluate client for mental and emotional acceptance of procedure
reduce pain and anxiety and support client
explain all the routine preop preparations and reinforce what the primary provider has discussed
answer any questions
review post-op care (deep-breathing, coughing, positioning, routine exercises
acknowledge client's feelings
protect client from any additional stress
assist w/ any daily activities
promote adequate sleep

47

REVIEW NURSING PROCESS FOR THE CLIENT AFTER A LIMB AMPUTATION

48

REVIEW NURSING GUIDELINES 61-5: STUMP CARE AND BANDAGING

49

REVIEW CLIENT AND FAMILY TEACHING 61-2

50

if a client reports that there affected limb w/ a cast is itching, what are some interventions to aid in relieving client?

anti-pruritis medication (hydrocortisone and benadryl)
cool air (never hot air)

51

if a client w/ a cast has cool, discolored skin and reports tingling, what should be done?

call the healthcare provider

52

what should be done if a client has a compound fractures to prevent infection?

protect wound w/ sterile dressing

Timby's Introductory Medical-Surgical Nursing: Chapter 61: Clients Requiring Orthopedic Treatment Flashcards