Orthopedic disorders

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  1. What is the cause of dysplasia of the hip?
    variety of conditions in which the femoral head and the acetabulum are improperly aligned
  2. What can cause dysplasia of the hip?
    • dislocation
    • subluxation
    • acetabular dysplasia
  3. what are risk factors to developing dysplasia of the hip?
    • females>male
    • 1st degree relative
    • intrauterine postioning
    • maternal increased estrogen levels
  4. What will be seen in a child with dysplasia of the hip?
    • limited abduction
    • affected hip can not be pressed back to hit the table
    • knee is lower
    • "click" heard as femoral head slips into acetabulum under gentle pressure
    • asymmetry gluteal and thigh fat fold
    • telescoping or pistoning of the thigh
  5. What is the overall management of a child with dysplasia of the hip?
    attempt to form a normal joint
  6. What type of treatment can be done at attempting to form a normal joint for a dysplasia hips?
    • keeping the head of the femur within the hip acetabulum
    • constant pressure to enlarge & deepen the acetabulum
  7. In order to try to correct dysplasia of the hip in a newborn what will be done?
    abduct the hips by using a Pavlick harness for 24 hours/day
  8. In order to try to correct dysplasia of the hip in a 3 months-3 years old what will be done?
    • Bryant traction for 20 hours/day for 3-4 weeks
    • stretches the soft tissue to allow the hip to be placed in the acetabulum
  9. In order to try to correct dysplasia of the hip in a 3 year old or older what will be done?
    • if its dislocated its reduced under general anesthesia
    • and spica cast to hold abduction for 5-9 months and changed every 6 weeks and may wear a brace after for 1-2 months
  10. What are factors of a congenital club foot?
    • boys>girls
    • bilateral or unilateral
  11. What will a child foot look like in a congenital club foot?
    • foot is directed downward, inward, forefoot adducted
    • foot is shorter with a shortened Achilles tendon
    • lower leg muscle atrophy
    • child walks on toes & outer borders of the feet
  12. How is congenital club foot treated at birth?
    long leg cast for 12 weeks and change every 1-2 weeks
  13. In mild cases of congenital club foot how is it treated?
    proper shoe to correct
  14. In sever cases of congenital club foot how is it treated?
    • surgery in 4-12 months followed by casting and corrective shoes
    • surgery to cut tendon and add pins in bones
  15. What are the responsibility of the nurse for a patient after surgery to correct club foot?
    • assessments (VS)
    • elevation
    • ice
    • pain manamgement
    • emotional support
  16. What is the manifestations of scoliosis?
    lateral, curvature, flexing laterally and rotating around it longitudinal axis
  17. Who is more likely to develop scoliosis?
    • 2-4% adolescents
    • girls>boys
    • 10-13 years of age
  18. What is the cause of scoliosis?
    • soft tissue shortening
    • vertebral shape and disk space abnormalities
    • fixed rotational deformity
    • thoracic curvature
  19. How might the ribs on the convex side of a patient with scoliosis be seen as?
    displaced posteriorly and widely spaced
  20. How might the ribs on the concave side of a patient with scoliosis be seen as?
    displaced anteriorly and narrowly spaced
  21. What are the main problems that can occur with a patient with scoliosis?
    • hips
    • knees
    • feet
    • heart
    • lungs
    • chronic pain
  22. How do we treat mild scoliosis curvature <20 degrees?
    • frequent evaluations
    • exercise program
    • may or may not wear brace
  23. How do we treat moderate curvature scoliosis 20-45 degree?
    • Milwaukee brace worn for 23 hrs/day
    • taken off for one hour to bathe or swim
    • Lateral electrical surface stimulation (LESS)
  24. How do we treat severe curvature scoliosis >45 degrees?
    • surgery-spinal fusion, done in stages, and Harrington rods in place until fusion is solid
    • after surgery wear a body cast for 6-9 months
    • after body cast wear a brace
  25. What happens when an individual has back pain?
    disk's central portion slips through the surrounding annulus fibrosus into the spinal canal, putting pressure on the nerve root
  26. What are causes of a patient having back pain?
    • lifting
    • twisting
    • direct injury
    • degenerating disk due to old age
    • weakened anulus
  27. Where is the most common back pain located at?
  28. What are the risk factors for developing back pain?
    • increased age
    • Lumbar herniation 20-45 yrs
    • Cervical herniation over 50 yrs
    • male>women
    • pregnant women
  29. What type of symptoms might a patient state they have with back pain?
    • pain worsening with activity, subsides with rest
    • unilateral or bilateral pain
    • sciatic never pain radiating down the leg
    • muscle spasms
    • weakness
    • sensory deficit (losing bladder control)
  30. How can we diagnose back pain?
    • Xray
    • CT scan
    • MRI
  31. What is the best way to prevent back pain?
    • Prevent back pain
    • good body mechanics
    • core conditioning
    • flexibility
    • normal body weight
  32. What can you tell a patient to do to help treat their back pain?
    • bed rest with body alignment
    • muscle strengthening exercise ASAP
    • PT
    • traction
    • ice-inflammation
    • heat-pain
    • muscle relaxants
    • analgesic
  33. What is the purpose of having a Laminectomy?
    • treats bony impingement on the nerve root when neuro involovment
    • removes lamina over the nerve root, then removal of the herniated nucleus pulposus
  34. Where is the incision located if your having a cervical laminectomy?
  35. Where is the incision located if your having a lumbar laminectomy?
  36. Define osteoarthritis?
    • progressive
    • non systemic
    • non inflammatory
    • bone & joint degeneration
  37. Which joints are affected with osteoarthritis?
    weight bearing joints: knee, hip, cervical and lumbar vertebrae & great toe, and also hands
  38. What are the reasons of having a primary cause of osteoarthritis?
    • no predisposing factors
    • hereditary
  39. What are the reasons of having a secondary cause of osteoarthritis?
    • trauma
    • congenital or developmental defects
    • other arthritic types
    • diabetes mellitus
  40. What are risk factors for developing osteoarthritis?
    • obesity
    • family history
    • history of excess use of same joint
    • history of joint injury
  41. What are complications of having osteoarthritis?
    • pain
    • flexion contractures
    • deformity
    • bony cysts, gross bony overgrowth
    • nerve root compression
  42. What do we want to tell the patient to do to treat osteoarthritis?
    • activity balanced with rest
    • physical therapy
    • heat/cold
    • exercise
    • assistive devices
    • drug therapy
    • surgery for joint replacement
  43. Define rheumatoid arthritis?
    • chronic
    • systemic
    • progressive inflammatory disease
    • immunologic changes
  44. which patients are more likely to have rheumatoid arthritis?
    • 20-50 years old
    • women>males
    • inherent tendency
  45. Which joints are most affected in rheumatoid arthritis?
    hands most affected bilateral
  46. What's the difference of how the joints on the hand will look like in rheumatoid vs. osteoarthritis?
    • rheumatoid: warm, tender swollen, and decreased ROM
    • osteoarthritis: not warm, not swollen
  47. What is the cause of rheumatoid arthritis?
    auto immune response within the synovial tissue inflamed>increased fluid>causing thickening synovia>causing granulated tissue>damages the cartilage, joint tissue, tendons, ligaments, and subcutaneous tissue>causes proteolytic enzymes are released>causing more destruction of the disease
  48. What are complications of rheumatoid arthritis?
    • flexion contractures: fingers flexed, turned laterally
    • tendon/muscle weakness
    • septic arthritis
    • nerve compression
    • skin ulceration
    • neuropathy
    • pericarditis
    • pulmonary
    • pleural disease
    • interstitial fibrosis
  49. What type of treatment are used for rheumatoid arthritis?
    • surgery for joint replacement
    • drug therapy: NSAIDs, steroids, gold containing agents, immunosuppressive drugs
  50. What is the primary cause of Gout?
    uric acid over production &/or retention
  51. What is the secondary cause of gout?
    drugs or other disease state
  52. What types of symptoms will a person with gout be seen having?
    • abrupt swelling tenderness & pain in joint that last several weeks
    • very painful want nothing to touch
    • symptoms worse with each attack
  53. What are causes of a GOUT flare up?
    • surgery
    • minor trauma
    • excessive alcohol
    • foods high in fats/proteind
  54. which joint is most affected by GOUT?
  55. What type of treatment will be given for a patient with a GOUT attack?
    • anti-inflammatory
    • colchicine-acute phase
    • indomethacin
    • corticosteroids
    • allopurinol
    • sulfinpyrazone
    • rest
    • heat/cold
    • diet change
    • weight loss
    • hydration
  56. What is the indication for allopurinol?
    reduces uric acid production taken every day
  57. What is the indication for sulfinpyrazone?
    decrease serum uric acid
  58. Define systemic lupus erythematose?
    • chronic collagen vascular disease
    • autoimmune disease
  59. Which type of the body systems does lupus affects?
    • multiple body systems affected (changes from individual to individual)
    • producing widespread to connective tissues, blood vessels, and serous/mucous membranes
  60. what type of symptoms would a patient complain of if the have lupus?
    • facial erythematic (butterfly rash)
    • alopecia
    • stiff aching joints
    • musculoskeletal deformity/pain
    • photosensitivity
    • fatigue
    • weight loss
    • remissions & exacerbations
  61. What are other complications that can arise from Lupus?
    • pleural effusions (lungs)
    • heart problems
    • Lupus nephritis (kidney)
    • arthritis
    • Raynaud's phenomenon (fingers)
  62. What are primary treatments for a patient with lupus?
    • NO CURE
    • prevent exacerbations
    • suppress inflammation
    • relieve symptoms
    • immunosuppressive medications
    • plasmapheresis
    • emotional support
  63. What are the primary cause of hip fractures?
    • TIA's (cardiac problem)
    • hypotension
    • poor vision
    • falls
  64. what are risk factors for a patient of having a hip fracture?
    • increased age
    • women>males
    • osteoporosis
    • sedentary lifestyle
    • weakened quadriceps
  65. What type of fracture is a intracapsular fracture and what is the problem with this one?
    • fracture of the femurs head and neck
    • has slow healing due to limited blood supply
  66. What type of fracture is a extra capsular fracture and what is the problem with this one?
    • fracture in femurs trochanteric region
    • has good healing due to good blood supply
  67. What type of things would you see in a patient with a hip fracture?
    • pain in hip, groin, or knee that worse with movment
    • affected limb is rotated and shortened
    • muscle spasms
    • hematoma and ecchymosed
  68. what tings can we use to diagnose a hip fracture?
    • X-ray
    • decreased hemoglobin
    • elevated enzymes & blood glucose
  69. What types of treatments are we going to do for a patient with a hip fracture?
    • Bucks traction especially before surgery
    • surgery (open reduction, internal fixation or replacement)
    • pain meds
  70. What are complications of a patient with a hip fracture?
    • pain
    • skin & soft tissue injuries
    • nerve injuries
    • vascular complications
    • delayed, incorrect or non union of bone
    • secondary infections
    • adhesions and joint stiffness
    • fat emboli syndrome
  71. What are the causes of having a joint replacement?
    • 1. arthritic or injury induced inflammation
    • 2. abnormalities after fracture healing
    • 3. physiologic changes from aging
    • 4. cartilage degeneration
  72. What patients are most like to have a hip replacement with a shell mesh replacement and why?
    • younger patients
    • they work longer
    • but patient cant walk for 3 months after surgery
  73. What patients are most like to have a hip replacement with a glue cup replacement and why?
    • older patients
    • they can get up and walk next day
  74. After surgery of a patient with a hip replacement what is the nurse going to mainly focus on?
    • pain management
    • position patient with abductor pillow & hip rolls
    • teach them not to cross legs
    • monitor dressing and drains
    • ambulation
    • monitor for signs of dislocation
  75. What are signs of a hip replacement being dislocated?
    • worsening pain
    • shortening of leg
    • popping sound
  76. What types of things are going to be used when a patient has had a total knee replacement?
    • CPM
    • ICE
    • Auto transfusion (during surgery)
  77. What are the causes of a person getting an extremity amputated?
    • trauma
    • vascular insufficiency (diabetes)
    • cancer
    • infection
  78. After a patient had a amputation what things is a nurse going to teach them?
    • elevate extremity for first 24 hours after
    • start ROM after 24 hours
    • avoid external rotation or abduction
  79. What are the main complications of having an amputation?
    • contractures
    • phantom pain
    • hematoma
    • necrosis
    • wound dehiscent
    • gangrene
  80. When should a nurse be most concern with a patient developing compartment syndrome?
    2 hours to 6 days following surgery or trauma
  81. What are signs/symptoms that a patient might experience with compartment syndrome?
    • pain
    • pallor
    • pulselessness
    • paralysis
    • paresthesia
    • cyanosis
  82. What is the priority treatment for compartment syndrome?
    release pressure by doing a surgery to split the fascia envelope
  83. What are complications of compartment syndrome?
    • ischemia (histamine release>edema>blood vessel compression
    • neurologic (due to pressed damaged nerves
    • contractures (fibrous tissue that replaces ischemic muscles & tendons
  84. What types of things cause compartment syndrome?
    • fractures
    • crushing injuries
    • internal pressure or bleeding
  85. What areas are most affected by compartment syndrome?
    • lower leg
    • forearm
    • thigh
    • others: shoulder, hand, butt, and foot
  86. How does compartment syndrome occur?
    fascia is unable to expand for the blood and causes muscles to swell pressing occluding nerves & blood vessels
Card Set:
Orthopedic disorders
2013-11-18 23:27:48
theory test

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