Exam 20: Orthopedic Surgery

Colles' (wrist)fracture is a dorsally angulated fracture of the distal end of the radius.Most of these fractures can be managed successfully with closed reduction and immobilization,but external fixation is especially useful in the case of a comminuted intra-articular fracture.Internal fixation with Kirschner wires (K wires)is indicated when the distal end of the radius is severely comminuted and displaced.Select the nursing considerations for a patient with a Colles' fracture fixation.

The vertebral bodies are connected by several cartilaginous joints.What purpose does this connection enable?

A 50-year-old woman with degenerative rheumatoid arthritis is having a two-joint metacarpophalangeal implant of her left hand.The pneumatic tourniquet is applied to the patient's upper left arm and has been inflated to 280 mm Hg for 38 minutes.The surgery is advancing as planned,and the surgeon is preparing to insert the second implant.The perioperative nurse circulator has set the time threshold for 60 minutes.During her preoperative assessment,the nurse noted no contraindications to pneumatic tourniquet use.While the surgery is going well,and the nurse is confident that the second implant will be inserted and the wound closed before the tourniquet alarms,which risk reduction strategy would be appropriate for the nurse to employ?

Select the true statement about application and operation of the pneumatic tourniquet.

A cancellous bone graft consists of spongy bone usually taken from the anterior or posterior crest of the ilium.A cortical bone graft,consisting of hard,dense bone,is removed from the crest of the ilium or the tibia.Why is the ilium a desirable site for graft harvest?

Bone grafting using allografts or autografts may be used to fill cavities after removal of large amounts of bone that might result in instability,or to fill bony defects and to promote the union of fractures at the time of open reduction.Banked bone is available in many shapes of cortical and cancellous tissue.The American Association of Tissue Banks (AATB)accredits and periodically inspects bone-banking programs to ensure that specific standards are followed in the retrieval,processing,storage,and distribution of bone grafts.Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer,monitored with an alarm,would be considered a(n):

The surgeon may treat distal limb fractures with a closed reduction,rather than open or external fixation,manipulating the fragments into position without incising the skin.When possible,this is the treatment of choice because it decreases the opportunity for infection,improves results (including bone union of the fracture),and minimizes the recovery period.Closed reduction with local or light anesthesia may permit ambulatory surgery.Select a situation where closed reduction would be performed in addition to open reduction and fixation surgery to a distal limb.

A long bone fracture in a child can have devastating consequences in terms of the child's skeletal maturity and potential for limb shortening and malformation when the fracture line involves the:

Vertebroplasty and kyphoplasty are used for the treatment of vertebral compression fractures attributable to osteoporosis or pathologic conditions.Bone cement is injected into the vertebral body to decrease back pain and prevent further vertebral body height loss.Equipment includes C-arm,radiolucent OR bed,and X-ray vests for staff as well as bone biopsy needles,vertebroplasty system,and cement injection system.An important nursing consideration relevant to this interventional radiology-assisted procedure would be to:

An objective assessment of the patient's condition,in terms of assigning an appropriate preoperative surgical diagnosis and plan of care,would be obtained from:

Bone healing follows a logical sequence beginning with the formation of a hematoma.Select the action that typically occurs after formation of a hematoma.

Paget's disease is a disorder affecting older adults.The bones are weak and poorly constructed.This degenerative process results in:

Ligaments are best defined as:

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone,which leads to a reduced absorption of calcium and phosphorus.This malabsorptive condition is due to a deficiency of ______________ that can be treated by __________________.

In an open anterior cruciate ligament (ACL)repair,an examination under anesthesia (EUA)is performed immediately after induction of anesthesia,when the ligaments are completely lax,to evaluate the severity of the injury.The surgeon then makes a straight midline or slightly medial incision across the knee.Arthroscopic repair causes less patellar pain and decreased disturbance of extensor mechanisms.What preoperative indicators contribute to selecting the surgical approach (open or arthroscopic)of choice?

The rotator cuff consists of which group of muscles?

Open reduction and internal fixation (ORIF)is a method of providing exposure of the fracture site and using pins,wire,screws,a plate and screw combination,rods,or nails to correct the fracture.Surgeons use ORIF when they are unable to reduce a fracture by closed methods,and skeletal traction is not indicated.What would be an advantage for an open rather than a closed fracture reduction technique?

While not as prevalent as arthroplasty of the shoulder,knee,or hip,total elbow replacement is indicated for patients with traumatic lesions or excessive bone loss from rheumatic or degenerative arthritis,resulting in elbow instability and pain or bilateral elbow ankylosis.The prosthesis may be used with or without PMMA,depending on the quality of the diseased bone and the design of the implant.If PMMA is not used,what replacement product,element,or substance is used?

Before surgery,the perioperative nurse reviews the patient record,noting relevant aspects of the history and physical examination; the nature of the problem and its onset; and results of radiographic studies,laboratory data,and other findings.The nurse investigates the patient's range of motion,neurovascular status,and general condition.The patient's perception and understanding of the surgical procedure and postoperative rehabilitation is determined,and patient education is begun.Such activities reflect which important part of the nursing process?

A 68-year-old retired woman has chronic joint pain in both knees and hips.She does not have osteoarthritis but is overweight and sedentary.While she believes she needs to convince her orthopedic surgeon that she should be considered a candidate for joint replacement surgery,her neighbor,a perioperative orthopedic nurse,is teaching her about the role of cartilage in the joints and how to prevent further injury.The neighbor has convinced the patient to join her in stretching exercises and a daily walk through the neighborhood.This program can help prevent degenerative conditions because: