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NURS 6901 ORTHOPEDIC SURGERY COMPLETE EXAM
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NURS 6901 ORTHOPEDIC SURGERYCOMPLETE EXAM
What are preoperative orthopedic surgery considerations? - ANSWER 1. Age
2. CV
3. Neurologic
4. Hematologic
What are the age considerations for someone undergoing orthopedic surgery? -
ANSWER -Patients requiring ortho surgery are getting older, however, age is not a
limiting factor (because elective ortho surgery can increase QoL)
-Increased age is at higher risk of:
1. Pneumonia
2. Death
3. UTI
4. Extended hospital stay
5. Need for blood transfusion
What are the CV considerations for someone undergoing orthopedic surgery? -
ANSWER 1. Ortho surgery is considered an intermediate risk surgery
2. Hip/knee arthroplasties are at higher risk for period MI (does not go away for 3
months, the highest risk is one-month post-op)
3. R-sided HF patients are at higher risk of CV events
** Must assess CV status (MET) score
What are the neurologic considerations for someone undergoing orthopedic
,surgery? - ANSWER 1. Higher risk of stroke (can be patient-related or
surgery-related)
2. Post-op delerium can occur (highest for hip frx repairs)
What are the hematologic considerations for someone undergoing orthopedic
surgery? - ANSWER 1. Thrombotic event is the leading cause of morbidity and
mortality in ortho surgery
2. Must balance and carefully consider when to D/C anticoagulants and restart them
with bleeding vs. clot risk.
3. Knee/hip arthoplasty = intmdt risk of bleeding
4. vertebrospinal = higher risk of bleeding
5. the mote bony the area, the more risk of bleeding
When should you stop anti-vitamin K (Warfarin) before a ortho surgery? -
ANSWER Before block: Hold 5 days prior
May remove catheter when: INR <1.5
When should you stop NSAIDs/Aspirin before a ortho surgery? - ANSWER May
proceed neuraxial surgery if:
-Normal clotting mechanisms
-Not on other blood thinning agents
When should you stop subcutaneous heparin (for DVT prophylaxis) before a ortho
surgery? - ANSWER May proceed neuraxial surgery if:
-Normal clotting mechanisms
-Not on other blood thinning agents
When should you stop IV heparin before a ortho surgery?
Pre/post block
Catheter removal - ANSWER 1. Hold 2-4 hr before block
2. Hold 1 hr after block
, 3. Hold 2-4 hrs after catheter removal
When should you hold low-molecular-weight heparin (enoxaparin) before an ortho
surgrey?
Pre-block
Pre/post catheter removal
Oneshot block - ANSWER Prior to block:
Prophy dose (1x a day): 12 hrs prior
Therapeutic dose (2x a day): 24 hrs prior
Before catheter removal: 12 hrs prior
Post-catheter removal: 2 hrs
One shot block:
Prophy: 6-8 hrs
Therapeutic: 12 hrs
What are special populations to consider with orthopedic surgery? - ANSWER 1.
Osteoarthritis
2. Rheumatoid arthritis
3. Ankylosing spondilitis
4. Osteogenesis imperfecta
5. Cerebral palsy
6. Spina bifida
7. Duchennes
Osteoarthritis - ANSWER Wear and tear of the joints, pain is usually better in the
morning and worsens wiht activity
Anesthesia considerations for someone with osteoarthritis - ANSWER 1. Consider
comorbidities they may have developed from prolonged limited physical activity
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