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Chapter 61: Clients Requiring Orthopedic Treatment

front 1 rigid mold that immobilizes an injured structure while it heals 3 types: cylinder, body cast, hip spica	back 1 Cast
front 2 encircles an arm/leg, leaving the fingers and toes exposed	back 2 cylinder cast
front 3 larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests	back 3 body cast
front 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	back 4 spica cast

front 5 How should a client w/ a spica cast be positioned while the cast dries?	back 5 feet are positioned so that they support the desired body alignment and is resting on pillows until the cast dries
front 6 How are bone fragments kept aligned for clients w/ a cast?	back 6 the cast is applied from the joint above the break to the one below it the joint is slightly flexed to decrease stiffness
front 7 REVIEW BOX 61-2: APPLYING A CAST MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST	back 7 REVIEW BOX 61-2: APPLYING A CAST MAKE SURE THERE ARE NO CREASES. SMOOTH OUT LAYERS AND EDGES OF THE CAST
front 8 How should a wet cast be kept?	back 8 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

front 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	back 9 Cast windows
front 10 What are some things that may be expected after a cast removal? What are some interventions to help with what is expected?	back 10 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
front 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	back 11 splint
front 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	back 12 braces

front 13 REVIEW NURSING GUIDELINES 61-1	back 13 REVIEW NURSING GUIDELINES 61-1
front 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	back 14 Traction skin traction skeletal traction
front 15 achieved by applying devices to the skin that indirectly affect the bones or muscles examples: buck and russell traction	back 15 Skin traction
front 16 REVIEW BOX 61-3: PRINCIPLES OF EFFECTIVE TRACTION	back 16 REVIEW BOX 61-3: PRINCIPLES OF EFFECTIVE TRACTION

front 17 REVIEW NURSING GUIDELINES 61-2: MANAGING THE CARE OF THE CLIENT IN TRACTION	back 17 REVIEW NURSING GUIDELINES 61-2: MANAGING THE CARE OF THE CLIENT IN TRACTION
front 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	back 18 Closed reduction
front 19 performed in the operating room the bone is surgically exposed and realigned x-rays are taken to ensure correct alignment	back 19 Open reduction
front 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	back 20 Internal fixation

front 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	back 21 External fixation
front 22 since pin sites are an entry for infection, what should be monitored for?	back 22 redness drainage tenderness
front 23 REVIEW NURSING PROCESS FOR THE CLIENT W/ A FRACTURE REDUCTION	back 23 REVIEW NURSING PROCESS FOR THE CLIENT W/ A FRACTURE REDUCTION
front 24 REVIEW NURSING GUIDELINES 61-3: PROVIDING PIN CARE	back 24 REVIEW NURSING GUIDELINES 61-3: PROVIDING PIN CARE

front 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	back 25 Orthopedic Surgery
front 26 total reconstruction or replacement of a joint w/ an artificial joint to restore function and relieve pain ex. hip and knee surgery	back 26 Arthroplasty
front 27 Post-op complications for clients who've had orthopedic surgery?	back 27 hemorrhage subluxation: dislocation of the joint infection thromboembolism avascular necrosis (death of bone tissue b/c of diminished/absent blood supply)
front 28 Depending on the type of joint replacement, what may the client be asked to do?	back 28 donate their blood preoperatively just in case it has to be used postoperatively if transfusion is required

front 29 What are very important for clients who have a knee or hip replacement surgery?	back 29 early ambulation: goal is to have client bend the knee @ 90 degrees by discharge anticoagulant therapy
front 30 Pre-op nursing management care for clients undergoing orthopedic surgery	back 30 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
front 31 REVIEW NURSING GUIDELINES 61-4: ENSURING COMPLETE CARE FOR CLIENTS BEFORE ORTHOPEDIC SURGERY	back 31 REVIEW NURSING GUIDELINES 61-4: ENSURING COMPLETE CARE FOR CLIENTS BEFORE ORTHOPEDIC SURGERY
front 32 Post-op nursing management care for clients undergoing orthopedic surgery	back 32 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

front 33 How should a client w/ a total hip replacement be positioned?	back 33 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
front 34 REVIEW BOX 61-5: AVOIDING HIP DISLOCATION AFTER CONVENTIONAL REPLACEMENT SURGERY	back 34 REVIEW BOX 61-5: AVOIDING HIP DISLOCATION AFTER CONVENTIONAL REPLACEMENT SURGERY
front 35 REVIEW TABLE 61-2: PREVENTING POST-OP COMPLICATIONS AFTER JOINT REPLACEMENT SURGERY	back 35 REVIEW TABLE 61-2: PREVENTING POST-OP COMPLICATIONS AFTER JOINT REPLACEMENT SURGERY
front 36 TRUE OR FALSE? if a client has pins and screws, they should be sure to let someone know before getting a MRI	back 36 TRUE

front 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	back 37 Fat embolus
front 38 REVIEW NURSING CARE PLAN 61-1: THE CLIENT UNDERGOING ORTHOPEDIC SURGERY	back 38 REVIEW NURSING CARE PLAN 61-1: THE CLIENT UNDERGOING ORTHOPEDIC SURGERY
front 39 REVIEW CLIENT AND FAMILY TEACHING 61-1: HOME CARE AFTER A LIMB AMPUTATION	back 39 REVIEW CLIENT AND FAMILY TEACHING 61-1: HOME CARE AFTER A LIMB AMPUTATION
front 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	back 40 amputation

front 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	back 41 Open amputation (guillotine method)
front 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	back 42 Closed amputation
front 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	back 43 Stage amputation
front 44 Complications post-op amputation?	back 44 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

front 45 what are some interventions for phantom pain?	back 45 massage the limb
front 46 Presurgical Nursing management for clients getting amputations?	back 46 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
front 47 REVIEW NURSING PROCESS FOR THE CLIENT AFTER A LIMB AMPUTATION	back 47 REVIEW NURSING PROCESS FOR THE CLIENT AFTER A LIMB AMPUTATION
front 48 REVIEW NURSING GUIDELINES 61-5: STUMP CARE AND BANDAGING	back 48 REVIEW NURSING GUIDELINES 61-5: STUMP CARE AND BANDAGING

front 49 REVIEW CLIENT AND FAMILY TEACHING 61-2	back 49 REVIEW CLIENT AND FAMILY TEACHING 61-2
front 50 if a client reports that there affected limb w/ a cast is itching, what are some interventions to aid in relieving client?	back 50 anti-pruritis medication (hydrocortisone and benadryl) cool air (never hot air)
front 51 if a client w/ a cast has cool, discolored skin and reports tingling, what should be done?	back 51 call the healthcare provider
front 52 what should be done if a client has a compound fractures to prevent infection?	back 52 protect wound w/ sterile dressing