Orthopedic Nursing Exam 87 Questions with Verified Answers,100% CORRECT

Orthopedic Nursing Exam 87 Questions with Verified Answers 5 Steps in Bone Healing - CORRECT ANSWER 1. Hematoma 2. Fibrocartilaginous Callus 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