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Orthopedic 8

  1. Wound healing
    1. aseptic dressing change technique
    2. compression dressing wrapped in a figure eight fashion or cast to control edema
  2. Altered body image
    1. may take months to resolve
    2. must convey acceptance and respect for individual
    3. foster independence: encourage client to look at, feel, and eventually care for limb
  3. Grief
    1. many clients go through a mourning process, shock, anger, and depression
    2. caregivers should support and listen actively
  4. Restoring physical mobility
    1. early rehabilitation
    2. muscle strengthening exercises
    3. prosthetic preparation 
  5. Types of prosthesis
    1. hydraulic
    2. pneumatic
    3. biofeedback - controlled
    4. myoelectrically controlled
    5. synchronized
  6. Arthroscopy
  7. Definition - endoscopic procedure that allows direct visualization of the joint, most often performed on knees and shoulders
  8. Indications
    1. torn medial and lateral meniscus
    2. chondromalacia patellae
    3. synovitis
    4. torn cruciate ligament
    5. subluxation patella
    6. intra-articular soft tissue mass
    7. pyarthrosis
  9. Surgical procedure - most often, office surgery
  10. Postoperative care
    1. compression dressing wrapped in a figure eight fashion to control edema
    2. ice may be applied
    3. oral analgesics for pain management
    4. weight bearing depends on procedure
  11. Postoperative complications are rare
    1. infection
    2. thrombophlebitis
    3. stiffness
  12. External fixator
  13. Definition 
  14. Indication: the device will stabilize fracture with soft tissue injury like crush fractures
  15. Procedure: fracture aligned and immobilized by pins of Kirschner wires inserted in the bone and attached to a rigid frame outside the body
  16. Nursing interventions
    1. monitor neurovascular status every two hours
    2. elevate extremity to reduce edema
    3. assess pin insertion sites for infection: erythema, drainage and increased warmth
    4. isometric and active exercises as prescribed
    5. non-weight bearing ambulation depends on soft tissue injury
    6. discharge teaching
      1. ambulation with assistive device (crutches, walker)
      2. care of pin site
      3. extremity is repositioned by lifting frame instead of extremity

  • After hip replacements, pulmonary embolism may occur even without thrombosis in foot or leg.
  • Clients should sit in a straight, high chair; use a raised toilet seat; and never cross their legs.
  • In hip or knee replacement, clients will need assistive devices for walking until muscle tone strengthens and they can walk without pain.
  • After an amputation, the home must be assessed for any modifications needed to ensure safety.
  • Some clients will need transportation to continue rehabilitation.
  • Amputee support groups can help clients and family.
  • After arthroscopy, outpatient rehab may be prescribed depending on procedure; health care provider may prescribe knee immobilizer.
  • External Fixator - If possible, prepare the client preoperatively to reduce anxiety. Device looks clumsy, but patient should be reassured that discomfort is minimal.
  • After a hip pinning or femoral-head prosthesis, caution client not to force hip into more than 90 degree of flexion, into adduction or internal rotation which will cause dislocation and severe pain and this would be a nursing emergency.
  • Caution clients with a new prosthesis not to use any substances such as lotions, powders etc. unless prescribed by the health care provider.
  • Osteoporosis cannot be detected by conventional X-ray until more that 30% of bone calcium is lost.
  • Foods high in calcium include milk, cheeses, yogurt, turnip greens, cottage cheese, sardines, and spinach.
  • When performing a musculoskeletal assessment on a client with Paget's disease, note the size and shape of the skull. The skulls of these clients will be soft, thick and enlarged.
  • Clients at high risk for acute osteomyelitis are: elderly, diabetics, and clients with peripheral vascular disease.
  • When clients receive corticosteroids long-term, evaluate them continually for side effects.
  • Immunosuppressed clients should avoid contact with persons who have infections.
  • Steroids may mask the signs of infections, so client should promptly report slightest change in temperature or other complaints.
  • Photosensitive clients should avoid the sun, limit outdoor activities during peak sun hours and wear sun block.

Abduction device
Ankylosing spondylitis
Carpal tunnel syndrome
Charcot's joint
Colles' Fracture
Cruciate ligament
Diarthroidial joint
Discoid Lupus Erythematosus
Ewing's Tumor
Haversian system
Intra-articular soft tissue mass
Isometric exercises
Kirschner wire
Lyme Disease
Swan-neck deformity
Systemic Lupus Erythematosus