Orthopedic Nursing Exam 87 Questions with Verified Answers
5 Steps in Bone Healing - CORRECT ANSWER 1. Hematoma
2. Fibrocartilaginous Callus
... [Show More] Formation
3. Bony Callus Formation
4. Remodeling
Hematoma - CORRECT ANSWER -inflammatory process
-cell migration to area
Fibrocartilaginous Callus Formation - CORRECT ANSWER -starts within 48 hours
-granulation replaces hematoma
-osteoblasts build a web of collagen fibers (3 weeks)
Bony Callus Formation - CORRECT ANSWER -starts in 3-4 weeks
-new bone
-osteoclasts invade: reabsorbs excess callus as it is replaced by mature bone
Remodeling - CORRECT ANSWER -2-4 months
-plates/bars are laid down
-repaired along lines of stress
Factors in Bone Healing - CORRECT ANSWER - calcium
- vitamin D
- Alkaline Phosphate
- Decreased circulation
- No osteoporosis
- no infection
Diagnostic Radiology - CORRECT ANSWER - Xray
- MRI
- Bone Scan
- Myelogram
Myelogram - CORRECT ANSWER - check for allergies (Shell fish)
- dye used
CSF - CORRECT ANSWER - clear
- appears on a dressing as a green halo
Dislocation - CORRECT ANSWER - loss of articulation of the bone ends in the joint caps
Subluxation - CORRECT ANSWER - partial dislocation where bone ends still partially touch
Nursing Care - Joint Trauma - CORRECT ANSWER - Risk for Injury
- Acute Pain
- Impaired Physical Mobility
Ice / Heat - CORRECT ANSWER - 20 minutes on, 20 minutes off
Bursitis - CORRECT ANSWER - inflammation of bursa
Epicondylitis - CORRECT ANSWER - Tennis Elbow
- inflammation of tendon at point of origin to bone
Carpal Tunnel Syndrome - CORRECT ANSWER - compression of median nerve and inflammation of the lining of the synovial sheath
- less room compresses nerves and causes pain
Treatment for Repetitive Injuries - CORRECT ANSWER - Conservative
- Surgery
Conservative Treatment for Repetitive Injuries - CORRECT ANSWER - immobilize and rest
- ice for 20-48 hours and then heat
- medicate ( NSAIDS/Corticosteroids)
Surgical Treatment for Repetitive Injuries - CORRECT ANSWER - bursitis & epicondylitis : remove calcified deposits
- Carpal Tunnel : resect carpal ligament to enlarge tunnel (make opening bigger)
Fracture - CORRECT ANSWER - a break in the continuity of the bone
symptoms - pain, deformity, edema, crepitus
Complete vs. Incomplete Fractures - CORRECT ANSWER total segment transaction vs partial
With vs Without Displacement Fracture - CORRECT ANSWER unstable vs stable
-same position or shifted
Simple vs Compound Fracture - CORRECT ANSWER closed vs open
Fracture Impact - CORRECT ANSWER - muscles
- blood vessels
- nerves
- tendons
- results : soft tissue damage, blood loss, edema
Goal of Reduction - CORRECT ANSWER - fix fracture
- approximate segments
- restore normal position
Closed Reduction - CORRECT ANSWER - manual manipulation of skin
Open Reduction - CORRECT ANSWER - surgical manipulation of bone
Immobilization - CORRECT ANSWER - goal : fixation/alignment of segments
Methods of Immobilization - CORRECT ANSWER - Internal fixation
- External fixation
Internal Fixation - CORRECT ANSWER - pins, plates, rods, hardware
- advantages = fast ambulation
- disadvantages = surgery is required
External Fixation - CORRECT ANSWER - casts, splints, external fixation devices (rods outside limb)
- advantages = may not require surgery, may allow for more movement
- disadvantages = cast require slow ambulation, no movement of limb, EFD requires surgery
ORIF - CORRECT ANSWER - open reduction internal fixation
Principles of Cast Care - CORRECT ANSWER - elevation
- turn/rotate
- skin edges - pad PRN
- pain control
- window/bivalve
- hot spots/drainage
- neuro checks
- cool air to relieve itching
Traction - CORRECT ANSWER - maintain the pulling force and direction of traction
- perform neuro checks
- assess for common complications of immobility
- teach reasoning behind traction
Neuromuscular Checks - CORRECT ANSWER - 5 P's
-pulses, pain, pallor, paresthesia,paresis
Maintenance of Traction - CORRECT ANSWER - maintain body alignment with direction of pull
- do not wedge the pts foot or place against floorboard
- weights hang freely and do not touch the floor
- nothing obstructing the ropes
- knots on rope are not in contact with the pulley
Skin Traction - CORRECT ANSWER - short term
- apply to skin
- low weight (under 10 lbs)
- immobilize and align
- muscle spasms
- splint/straps/wrap
Nursing Care for Skin Traction - CORRECT ANSWER - skin assessment (look for pressure areas)
- protect pressure sites
- remove weights if intermittent traction
- relieve muscle spasms
Skeletal Traction - CORRECT ANSWER - long term
- apply to the bone
- infection risk
- more weight (25+ lbs)
- immobilizers
- pins/wires/tongs
Nursing Care with Bone Traction - CORRECT ANSWER - NEVER remove the weights
- Provide pin care per policy
- report signs of infection at pin sites
Bone Grafting - CORRECT ANSWER harvesting bone to facilitate healing
Autograft - CORRECT ANSWER - from patient
Allograft - CORRECT ANSWER from donor
Sites Utilized for Bone Grafting - CORRECT ANSWER - iliac crest or the tibia
ORIF with ICBG - CORRECT ANSWER - open reduction internal fixation with iliac crest bone graft
Nursing Care Priorities with Fractures - CORRECT ANSWER - hemorrhage
- neurovascular assessment
- elevation
- mobilization
- SCD's
- Lovenox (heparin)
- O2
- IS q1hr, WA, DB + C
- pain control
- stool softeners
- fluid replacement
- monitor for infection
Systems of the Body with Priority - CORRECT ANSWER - skull (LOC, Pupils, Orientation)
- facial (respiratory)
- rib (respiratory)
Healing Complications - CORRECT ANSWER - delayed union
- non-union
- malunion
Delayed Union - CORRECT ANSWER - abnormal length of healing time (< than 6 months)
Non-Union - CORRECT ANSWER - no healing within 6-8 months
Malunion - CORRECT ANSWER - presence of false joint
- growth of fragments of bone in a faulty position
Osetomyelitis - CORRECT ANSWER - bone infection
- symptoms = fever, chills, redness, and drainage
- interventions = antibiotic therapy & hang hygiene with aseptic technique
Fat Embolus - CORRECT ANSWER - long bone fractures
- release of fat from exposed marrow
- fat breaks into fatty acid and attracts platelets
- occludes small vessels
- ischemia
- increased capillary permeability/rupture
- fluid shift = edema
Signs and Symptoms of Fat Emboli - CORRECT ANSWER - respiratory failure - hypoxia (tachycardia, tachypnea, fever)
- cerebral dysfunction (LOC, seizures, focal neurological deficits)
- petechiae ( chest, upper arms, axilla)
Nursing Care of Fat Emboli - CORRECT ANSWER - O2/pulse OX/ABGs
- Corticosteroids (decrease inflammatory response)
Compartment Syndrome - CORRECT ANSWER - within first 48 hours
- increased internal or external pressure in or on compartment
- entrapped nerves/blood vessels/muscle below the fascia
- Hypoxia, capillary dilation, edema, necrosis
Symptoms of Compartment Syndrome - CORRECT ANSWER - severe unrelenting pain
- cyanosis
- weakness
- parathesia
Warning for Compartment Syndrome - CORRECT ANSWER - arteries are outside the compartment so arterial pulses usually remain intact
Treatment of Compartment Syndrome - CORRECT ANSWER - decompressive fasciotomy
- antibiotics
- wet sterile NS dressings x 7-10 days
- pain management
DVT - CORRECT ANSWER - decreased blood flow
- injury to vessel wall
- altered blood coagulation
To diagnose DVT - CORRECT ANSWER - positive Homans Sign
- doppler studies
Treat with : Anticoagulants
Avascular Necrosis - CORRECT ANSWER - a result of obstructed blood flow
- loss of bone
- can occur prior to surgery or 4-6 months post surgery
Hip Fracture - CORRECT ANSWER - located proximal 1/3 of femur
- head, neck, trochanter region
Intracapsular Hip Fracture - CORRECT ANSWER - within the joint
- head or neck
Arthroplasty
Extracapsular Hip Fracture - CORRECT ANSWER - outside the joint
- trochanter region
ORIF (screw and hardware)
Nursing Care of Hip Fractures - CORRECT ANSWER - NO ADDUCTION
- foam splint or pillow between legs
- turn to unaffected side
- neurovascular checks Q4
- ambulate within 24 hours, use walker
- no flexion > 90 degrees (raised toilet seat)
- standard fracture care
Hip Resurfacing - CORRECT ANSWER - new
- replaces total hip replacement
- preserves more bone
- shave and cap the bone
- insert cobalt chrome implant
Advantages to Hip Resurfacing - CORRECT ANSWER - reduces post-op complications of dislocation and inaccurate leg length
- potential to last longer
- if fails, they can do THR
Total Knee Replacement - CORRECT ANSWER - 8-12 inch incision on front of joint
- damaged tissue on femur, tibia, and patella removed
- hardware applied
Hardware of a Total Knee Replacement - CORRECT ANSWER - femoral component = strong metal
- tibial component = durable plastic, held in metal tray
- plastic patellar component
Minimally Invasive Knee Replacement - CORRECT ANSWER - requires 3 inch incision on the side of the knee
- patients require 1/3 less therapy
- does not cut through quadriceps or tendons so less scarring
- rehab to recovery is 6 weeks total
Computer Assisted Orthopedic Surgery - CORRECT ANSWER - computer images are used to align knee implants
- less wear on prothesis
Uni-Compartment Knee Arthroplasty - CORRECT ANSWER - damage on one side of the knee
- only replace damaged compartment with implant
Shoulder Surgery - CORRECT ANSWER - arthroplasty (minimally invasive)
Amputations - CORRECT ANSWER - major problem is contractures
Spinal Fractures - CORRECT ANSWER - cord decompression is priority (spinal traction, steroids, airway stability)
Complete Spinal Cord Injuries - CORRECT ANSWER - across the entire cord
Incomplete Spinal Cord Injuries - CORRECT ANSWER - partial damage to cord
Levels of Spinal Cord Injuries - CORRECT ANSWER - at or above C8 = tetrapalgeia (quadriplegic)
- at or below T1 - paraplegic
- C1-C3 = death from cardio respiratory collapse
- C3-C5 = death from respiratory paralysis
Spinal Shock - CORRECT ANSWER - cervical or high thoracic injuries
- causes massive vasodilation
- flaccid paralysis below injury
- body temperature same as environment
- can start immediately and last 4-6 weeks (months)
Spinal Shock Symptoms - CORRECT ANSWER BP - hypotension
Pulse - bradycardia
Autonomic Dysreflexia - CORRECT ANSWER - Spinal cord injuries at or above T6
- triggered by stimuli that causes abdominal discomfort
- neurologic emergency
Autonomic Dysreflexia Symptoms - CORRECT ANSWER BP - Severe Hypertension
Pulse - Bradycardia
Back Pain Conservative Treatments - CORRECT ANSWER - exercise
- meditation
- steroid injections
Back Pain Surgical Treatments - CORRECT ANSWER - laminectomy
Nursing Care for Laminectomies - CORRECT ANSWER - incision
- neuro checks
- positioning = straight alignment
- log rolling
- post op interventions
Boomeritis - CORRECT ANSWER - not a official Dx
- inflammation found in the boomer generation related to people not knowing when to slow down with aging [Show Less]