Orthopedics NCLEX Exam 16 Questions with Verified Answers
Fractures
• Signs and symptoms - CORRECT ANSWER o Continuous pain; unnatural movement;
... [Show More] deformity is possible
o Shortening of the extremity b/c of muscle spasm
o Crepitus may occur from bones grating together
o Swelling and discoloration—worry about compartment syndrome
Fractures
• Treatment - CORRECT ANSWER o Immobilize the bond ends plus the adjacent joints otherwise causes continuous damage to occur
o To prevent further injury—support fracture above and below the site; and move extremity as little as possible
o A splint will help prevent fat emboli and muscle spasm
o With an open fracture you want to cover it, preferably with something sterile b/c at high risk for infection
o Neurovascular checks are done such as pulses,
color,
movement,
sensation,
capillary refill, and temp—
these are VERY important
Fracture Complications - CORRECT ANSWER Shock b/c bleeding can occur
Fracture
o Fat embolism - CORRECT ANSWER • Seen with long bones and crushing injuries; symptoms will depend on where it goes in the body
• Petechiae or rash over the chest;
conjunctival hemorrhages
• Occur in young males more b/c they are risk takers
• Snow storm on CXR (patchy infiltrates); usually occurs in the first 36 hours
Fracture
o Compartment syndrome - CORRECT ANSWER • This is when a fracture has not been elevated and has not had ice packs;
fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes swollen and hard and the pt complains of severe pain that is not relieved with pain meds
• Unpredictable; pain is DISPROPORTIONATE to the injury
• If undetected may result in nerve damage and possible amputation
• Common areas that this occurs are
forearms and quadriceps;
can get it without a fracture
Treatment
• Loosen the cast/bi-valve the cast;
only remove case if have bad neuro checks
• Fasciotomy will cut down to the tissue to relieve pressure
***be careful of the answer remove cast***
• Orthopedic nurses have cast cutters ready available; instruct the pt the cast saw does not touch the skin, but it does vibrate
Fracture Healing concerns - CORRECT ANSWER • Delayed union—healing doesn't occur at a normal rate
• Non-union: failure of bone ends to unite; may require bone grafting from person or cadaver
s/s of both: persistent discomfort and movement
• Cast care - CORRECT ANSWER o Ice packs on sides NOT on top especially first 24 hours b/c cast is still wet
o No indentations
o Use palm of hands for 1st 24hours b/c cast material is wet
o Keep uncovered and dry
o Do not rest on hard surface or sharp edge
o Cover cast close to the groin with plastic to prevent infection; be mindful of underlying diseases with cast care
Elevate and neurovascular checks
• If pt complains of pain, neurovascular checks and if pain meds are not helping think
compartment syndrome
• Traction - CORRECT ANSWER • Decreases muscle spasms, reduces (realigns the bone), and immobilizes
• Traction should be continuous; weights should hang freely
• Keep pt pulled up in bed and centered with good alignment—especially with the elderly
• Exercise non-immobilized joints
• Ropes should move freely and knows should be secured
• Egg crate use for comfort
• Foot boards are okay as long as they don't interfere with traction
• Skin traction - CORRECT ANSWER • This is when tape or some type of material is stuck to the skin and the weights pull against it; skin is NOT penetrated
• Types: Buck's traction—used most often with hip fractures; the leg is pulled straight out from the bottom by weighted traction
o Russell's—used most often with FEMORAL fractures; leg is help up by a brace then traction is pulling from the bottom of the leg with 3 pulleys
• Must do a good skin assessment
• With foot drop may need a boot to prevent it and keep it flexed
• Skeletal traction - CORRECT ANSWER • The traction is applied to the bones with wires and pins
• Used when prolonged traction is needed
• Types: Steinman pins, Crutchfield, Gardner-wells tongs, Halo vest
• Must monitor the pin sites and do pin care;
this is a sterile technique;
remove any crusts around pin sites b/c bacteria loves this area; serous drainage is okay b/c it's clear fluid but should be monitored
• If pin comes out call doctor! And make sure area where pin was is stabilize
Total Hip Replacement
• Pre-op care - CORRECT ANSWER o Buck's traction is used frequently pre-op to immobilize; elderly, malnourished pts may be in traction for several days to build up nutrition
• Post-op care
o Nursing considerations - CORRECT ANSWER • Neurovascular checks; monitor drain (don't want fluid accumulate in tissues) but not all have drains
• Pt can do isotonic exercises while in bed—squeeze and release muscles to build tone
• No weight-bearing until physician okays it
• Hydration is VERY important b/c pt is initially immobile
• Stresses should be minimal
Fracture Surgery
o Complications - CORRECT ANSWER • Dislocation will cause circulatory and nerve damage; s/s are shortening of leg, abnormal rotation, can't move extremity, PAIN
• Infection
• Prophylactic antibiotics (just like with a heart valve replacement)
• Remove Foley and suction ASAP if not needed; b/c these will serve as a portal for infection
• Avascular necrosis—death of tissue due to poor circulation; can't control but need to pick up quickly
• Immobility problems—walking is the BEST exercise
Amputations - CORRECT ANSWER performed at the most distal point that will heal; the doctor tries to preserve the knee and elbow b/c if have a joint with a prosthesis will have much more mobility
• Immediate post-op care
o Keep a tourniquet at bedside incase of hemorrhage; must stop bleeding
o Elevate on pillow for first 24 hours; then elevate foot of bed but don't keep propped up forever to prevent hip contracture
o Prevent knee/hip contracture by moving and straightening by extension of the joints; prone position extends knee and hip joints
o Phantom pain is REAL!!
• The first intervention to decrease phantom pain is diversional activity BEFORE pain meds
• Seen more with AKAs; usually subsides in 3 months but some will forever have phantom pain
***Pain: use other things first prior to pill; the definition of pain is what the pt says it is; ALWAYS assess the pt's pain by having them rate their pain on a pain scale (0-10) and document it***
o Pressure dressing post-op to prevent hemorrhage then also helps to shape limbs
The first intervention to decrease phantom pain is diversional activity - CORRECT ANSWER BEFORE pain meds
Amputation • Rehabilitation - CORRECT ANSWER o Limb shaping is important to be fit for prosthesis; shaped like a cone
o A limb sock to prevent rubbing against skin is worn under the prosthesis
o It's important to strengthen the upper body b/c a below the waist amputation needs upper body strength to move with crutches
o NOT okay to bear weight on a new stump/prosthesis
o It's okay to massage the stump to help promote circulation and decrease tenderness
o Teach pt to toughen stump to get it ready for prosthesis by pressing into a soft pillow; then a firm pillow; then the mattress; then a chair—progress as tolerated so it's not tender with prosthesis
• Walker—put in front, down on floor, walk in to it
• Crutches—do not rest on armpit, bear weight on hand or forearm—up with good leg first; down with bad leg first
• Cane—held on unaffected side/strong side [Show Less]