Transcript PVN 135E Review 2

PVN 135E Review #2
True/False
• Mark a “T” if the statement is true; an “F” if
the statement is false:
– A “contusion” is from a blow or blunt force trauma
that causes local bleeding under the skin
– A “sprain” causes microscopic muscle tears as a
result of overstretching muscles and tendons
– A “strain” refers to the wrenching or
hyperextension of a joint
Multiple Response (MR)
• RICE is an acronym referring to what action is
appropriate when soft tissue injury occurs?
• R=
• I=
• C=
• E=
Multiple Choice (MC)
• A temporary displacement of a bone from its
normal position is called a:
– A. Whiplash
– B. Sprain
– C. Dislocation
– D. Fracture
T/F
• A dislocation usually involves tearing of the
joint capsule ___
• Subluxations are partial or incomplete
dislocations ___
MR
• From the list below, indicate which symptoms
are usually present with a dislocation:
– A.
– B.
– C.
– D.
Pain
Deformity or shortening of the extremity
Limitation of movement
Edema
Other
• List 3 goals for nursing interventions related to
dislocations:
– 1.
– 2.
– 3.
MC
• Compression of the median nerve between
the carpal ligament and other structures
occurs with which condition?
– A. Volkman’s contracture
– B. Fractured wrist
– C. Carpal tunnel syndrome
– D. Brachial plexus injury
MR
• Which of the following clinical manifestations
would occur with carpal tunnel syndrome?
– A. Burning pain or tingling in the affected hand
– B. Inability to grasp or hold small objects
– C. Depressed appearance at the base of the
thumb on the palm side
– D. Edema of the hand, wrist or fingers
Other
• List 2 diagnostic tests used to determine
Carpal Tunnel Syndrome.
MR
• Treatment of Carpal Tunnel Syndrome could
include which of the following:
– A.
– B.
– C.
– D.
Use of immobilizer
Hydrocortisone injection
ROM exercises
Surgery
Other
• List 3 topics to be covered in the nurse’s
patient teaching session(s):
Other
• List 5 nursing interventions for post operative
care of a patient who had carpal tunnel
surgery for decompression of median nerve:
MC
• When given the medical diagnosis of
“herniated nucleus pulposus”, the doctor is
describing:
– A. Removal of a part of the vertebrae
– B. A traumatic injury to the vertebrae or disk in
which the continuity of the tissue is disrupted
– C. Pressure on the median nerve
– D. Rupture of the fibrocartilage surrounding an
intervertebral disk, releasing the nucleus pulposus
that cushions the vertebrae above and below
Other
• Which 2 areas of the body are affected by a
herniated nucleus pulposus?
MR
• Which of the following diagnostic tests would
be used to determine nerve involvement with
a herniated nucleus pulposus?
– A.
– B.
– C.
– D.
Myelography
EMG
CT scan
Physical Exam
Other
• Describe what “conservative” treatment for a
herniated nucleus pulposus would involve.
MR
• Which surgeries would a physician choose
that would be appropriate for treating HNP?
– A.
– B.
– C.
– D.
Laminectomy
Spinal fusion
Diskectomy
chemonucleolysis
Other
• List 2 preoperative care actions that could be
performed by the nurse for a pt. awaiting a
laminectomy:
MR
• Two overriding nursing goals for post
operative care of the pt. who had a
laminectomy include:
– A. Remove pressure on spinal nerves
– B. Provide ongoing assessment of neurological
status
– C. Promote healing of operative site
– D. Reduce headaches and pain
Other
• List 5 post op nursing interventions for a pt.
who had a laminectomy:
MC
• Back “precautions” for a post op laminectomy
patient would include which appropriate
“bed” position:
– A. Bed position should be completely flat at all
times
– B. HOB and FOB should be elevated 45⁰ at all
times
– C. HOB should be flat or slightly elevated; may use
a small pillow under knees prn
– D. Pt. must lie on left or right side at all times
T/F
• Pt./cgr./nurse must maintain a soft collar for
cervical laminectomy ___
• For laminectomy pt., pt./cgr./nurse should
ensure use of back brace as ordered ___
MR
• Maintaining good alignment post
laminectomy includes:
– A. keeping back straight with movement
– B. avoid twists and turns when getting out of bed
– C. turn to side and lower legs to floor when
getting out of bed
– D. use the overhead trapeze to swing out of bed
Other
• Amputations are performed for a number of
reasons. List 3 reasons for performing an
amputation:
MC
• One surgical technique used to treat a severed
limb is called “replantation”. This refers to:
– A. using a cadaver limb and attaching it to the
injured person
– B. using a healthy limb from an organ donor
– C. using the injured person’s own limb that has
been kept sterile and in ice water in a plastic bag
– D. Using an artificial limb
MR
• Medical goals for managing a patient
scheduled for amputation or presenting with
an injury that included loss of limb would
include:
– A. Measures to restore circulating blood volume
– B. Control pain
– C. Prevent wound infection
– D. Maintain adequate urinary output
Other (Amputation cont.)
• List 4 items of subjective data that the nurse
would obtain:
Other (Amputation cont.)
• List 3 items of objective data related to the
affected extremity:
MC
• After surgical repair of an amputated lower
extremity, one important nursing intervention
would include:
– A. Ensuring sufficient visitors for moral support
– B. Coordinating with Physical Therapy
– C. Ensuring menu delivery daily
– D. Providing diversional activities
Other
• List 5 post op nursing interventions r/t
amputation:
MC
• When a person experiences pain in the
missing extremity as though it were still
present, this is called:
– A.
– B.
– C.
– D.
Nerve Track syndrome
Phantom Limb pain
Chronic recurrent neurovascular spasms
Impulse message deficit
Other
• Why does phantom limb pain occur?
MC
• Nursing intervention related to phantom limb
pain would be aimed at:
– A. Effective pain management
– B. Referral to staff psychologist
– C. Early ambulation and use of unaffected
extremity
– D. Assisting pt. to adjust to a new normal
Complete
• __________ begins in physical therapy and
________ according to prosthesis situation.
Other
• Define “fracture” according to our text/lecture
notes.
MR
• Identify which of the following is a type of
fracture:
– A. open
– B. compound
– C. greenstick
– D. comminuted
Other
• List 6 clinical manifestations of a fracture:
MC
• Which is the most significant diagnostic test
that can confirm fracture in most cases?
– A. Ultrasound
– B. Serum Calcium level
– C. Radiographic exam (xray)
– D. Palpation
Other
• List 6 interventions that a physician would do
immediately once a fracture is confirmed:
MR
• For a person with a “closed” fracture, optimal
reduction is obtained through:
– A. Open surgery
– B. manual manipulation (closed reduction – no
surgery)
– C. Internal Fixation
– D. Traction
Other
• List 6 nursing interventions for a patient with a
fracture:
Other
• List 6 items to be included in patient teaching
for a patient with a fracture:
Identify each of the following fracture
types:
Identify the types of hip fractures:
MR
• Clinical manifestations of a hip fracture
include:
– A. Severe pain at the site
– B. Inability to move the leg voluntarily
– C. Shortening and/or external rotation of the leg
– D. Sustained plantar flexion
Other
• Medical management of a hip fracture may
include traction pre-operatively. Which
traction is the most common one used for this
purpose?
– A. skeletal traction
– B. Buck’s traction
– C. Crutchfield tongs
– D. Bryant’s traction
MR
• In preparing to repair Mrs. M’s fractured hip,
the choice of fixation devise that the doctor
will use depends on which 2 factors:
– A. How much mobility is hoped for post
operatively for the patient
– B. The location of the fracture
– C. The potential for avascular necrosis of the
femoral head and neck
– D. How much osteoporosis may be present
MR
• Before surgery, the nurse will be assessing
Mrs. M. regularly every 4 hrs. Two overriding
goals will guide these assessments. These are:
– A. Preventing shock and further complications
– B. Pt. education re: ambulation post-op
– C. Maintaining proper alignment through traction
and abduction of the hip when turning patient
– D. Maintaining balanced diet
Other
• Post operatively, what is the single most
significant behavior to teach the patient to
ensure success of the hip replacement surgery
and reduce possibility of dislocation of the
prosthesis?
Other
• When maintaining a patient in traction, the
following should be monitored and enforced:
– Weights: ___________________
– Alignment: ________________
– Bed wheels: _______________
MC
• Mr. J. is being admitted to the hospital for a
right knee arthroplasty. What will the doctor
be doing?
– A. Visual exploration of the joint capsule
– B. Incision and drainage of the knee capsule
– C. Replacement of the knee joint
– D. Special physical therapy with CPM machine
MR
• Anticipated outcomes related to Knee
Arthroplasty include which of the following:
– A. restoration of motion
– B. relief of pain
– C. correction of deformity
– D. improvement of hip joint function
Other
• Post op Knee Arthroplasty nursing
interventions include:
• List 6 interventions
Other
• What is “CPM”?
• Describe it’s functions and parameters.
Other
• Patient teaching for Knee Arthroplasty would
include:
Other
• Post op teaching for Total Hip Arthroplasty
would include:
Other
• Vertebral fractures can occur under what
circumstances? List below:
MR
• Clinical manifestations of a person with a
fractured vertebrae would include:
– A. Pain at the site of injury
– B. Partial or complete loss of mobility or
sensation
– C. Radiographic evidence of fx. or fx. Dislocation
– D. disorientation
Other
• Along with radiographic studies, a doctor may
perform a spinal tap on a person suspected of
having a fractured vertebrae. What is the
rationale for this?
Other
• Stable vertebral fractures would be treated
conservatively by a physician. What would
this include?
Other
• Treatment of unstable vertebral injuries would
include:
MR
• Nursing interventions for a person with a
vertebral fracture would include which of the
following:
– A. log rolling for position changes
– B. neurovascular assessments
– C. using stabilization devices
– D. elevating the HOB no more than 30⁰
MR
• Patient teaching for a patient with a fractured
vertebrae includes which of the following:
– A. Firm mattress
– B. Sitting straight in a firm chair, but for no more
than 20-30 min. at a time
– C. Proper lifting technique
– D. Follow MD lifting restrictions
– E. Back exercises
Other
• What situations could be responsible for a
fractured pelvis?
MR
• Clinical manifestations of a fracture in the
pelvic area would include:
– A. inability to bear weight without discomfort
– B. pelvic tenderness and edema
– C. hematuria
– D. signs of shock/hemorrhage
Other
• List 4 diagnostic tests that can be done to
determine the presence of a pelvic fracture:
Other
• Medical management is conservative unless
s/sx of hemorrhage or damage to any
abdominal organs are present. List 3
conservative measures:
Other
• Nursing interventions for clinical observation
and assessment of a person with a diagnosis
of pelvic fracture would include:
• List 7:
Other
• When working with a patient with a diagnosis
of pelvic fracture, patient teaching is an
important part of gaining patient cooperation
and preparation for discharge. List 3 areas of
information for patient teaching:
Other
• List 5 complications of fractures:
• Which is the most life-threatening
complication?
MR
• Shock is due to:
– A.
– B.
– C.
– D.
Blood loss
Pain
Fear
External compression
Other
• Describe the clinical manifestations of shock:
Other
• How is the blood volume restored when a
person is hemorrhaging?
Other
• Nursing responsibilities during treatment of
shock would include:
• List 8 interventions
• Compartment syndrome is another
complication of fractures. Within 4-6 hrs after
onset, irreversible damage can be done to the
area/limb involved.
• List 5 s/sx of compartment syndrome
Other
• Describe the process that occurs during
compartment syndrome:
MR
• During a situation where the risk for
compartment syndrome is high, nursing
responsibilities and interventions include
which of the following:
– A. Administration of analgesic and documentation
of relief obtained or not
– B. ↑ affected limb to level of heart
– C. apply cold packs and remove constricting
material
– D. Neurovascular checks frequently
MC
• A permanent contracture of the involved
extremity can occur if compartment syndrome
is not relieved soon enough. If it is in the
upper extremity, the hand can contract and
look like a claw. This is called:
– A. Trousseau’s sign
– B. Volkmann’s Contracture
– C. Brachial Plexus Deformity
– D. Atrophic spasm
MC
• When fat globules are released from the
marrow of a broken bone, they enter the
bloodstream and migrate to the lungs where
they obstruct the blood flow. This is now a
condition called:
– A. Thrombophlebitis
– B. Pulmonary Embolus
– C. Pulmonary edema
– D. Thoracic phlebitis
Other
• List 6 s/sx of a fat embolism:
Other
• Lab tests to confirm fat embolism include
changes in the following tests. Indicate what
the change is or what the test indicates:
– ABG’s :
– UA:
–H&H
Other
• List the treatments that may be used for fat
embolism:
Other
• Describe the cause of gas gangrene and the
process:
MC
• Among the clinical manifestations of gas
gangrene, ‘crepitus’ may be present. This is:
– A. necrotic skin at the site of infection
– B. foul odor from the wound
– C. gas bubbles under the skin
– D. petichiae on the neck and chest
MR
• Because medical interventions would include
establishing a larger wound to admit air and
promote drainage, nursing interventions
would include:
– A. strict aseptic technique with wound care
– B. autoclaving all contaminated equipment
– C. administration of antibiotics, analgesics
– D. excision of gangrenous tissue
MC
• When blood vessels are occluded by an
embolus, the condition is known as:
– A. pulmonary embolus
– B. Phlebitis
– C. Thromboembolus
– D. Fat embolism
MR
• If the embolus travels to the lungs, which
clinical manifestation(s) would the nurse
expect to observe:
– A. tachypnea
– B. dyspnea
– C. sharp chest pain
– D. cough
Other
• Medical management to treat
thromboembolus include anticoagulation
therapy. Nursing interventions would include:
• List 7
MC
• A device that immobilizes fractures by the use
of pins inserted through the bone and
attached to a rigid external metal frame is
called:
– A. Internal fixation device
– B. Traction
– C. Splint
– D. External fixation device
MR
• Nursing care for a patient with an external
fixation device includes which of the
following:
– A. pin site assessment and pin care
– B. maintain alignment
– C. frequent CMS checks
– D. pt. support and understanding
MC
• A cast or cast brace is an example of what kind
of intervention to treat a fracture:
– A. traction
– B. external fixation device
– C. non-surgical intervention
– D. advanced orthopedic device
MC
• A cast is applied:
– A. after the MD has properly aligned the bone
– B. only during surgery
– C. Pre-operatively until swelling is reduced
– D. In conjunction with an internal fixation device
MR
• Nursing interventions and assessment related
to a casted body part would include
neurovascular checks. What actions would
this assessment include?
– A. checking for the 7 P’s
– B. CMS checks
– C. Skin assessment – esp. at cast edges – skin care
and cast petaling
– D. Coordination with PT for ambulation plan
MR
• When a cast is wet, it is especially important
to handle it gently until dry. What actions
would this include?
– A. Set up a blow dryer aimed at different parts of
the cast to facilitate drying
– B. Elevate casted extremity on pillow x 24-48 hrs.
– C. Monitor and maintain shape and position of
cast
– D. use the bar on a spica cast to turn the pt.
MC
• Infection prevention and early detection are
crucial to healthy healing of the injured area.
What is an early sign of infection for someone
with a casted body part?
– A.
– B.
– C.
– D.
Foul odor
Itching
“Hot spot”
Bulging of cast
MC
• An acute obstruction of the duodenum may
occur in a patient with a hip-spica cast. The
chief symptom is Nausea. This situation is
called:
– A. third-spacing
– B. cast syndrome
– C. paralytic ileus
– D. gastric reflux
MC
• One nursing action to take if a patient shows
signs of cast syndrome is:
– A.
– B.
– C.
– D.
Give oxygen at 2 l/m immediately
Give pain medication
Encourage oral fluids
Prone the patient and notify the charge nurse
T/F
• When a patient experiences itching (pruritis)
inside the casted area, a well padded wood or
wire device may be used to “scratch” the area.
MC
• A cast brace is an alternative appliance to
traditional leg cast and is most effective for a
fracture of the femur. The feature that
provides for additional support and mobility
is:
– A.
– B.
– C.
– D.
Lighter weight plaster of Paris
A hinge on the device
Can be fit for a walker scooter
Keeps swelling down
MC
• The process of putting an extremity, bone, or
group of muscles under tension by means of
weights and pulleys is called:
– A. traction
– B. cast brace
– C. casting
– D. pinning
Other
• List 5 functions of traction:
MC
• Which type of traction is applied directly to
the bone with the use of wires or pins inserted
distal to the fracture site?
– A. Crutchfield tongs
– B. Buck’s traction
– C. Russell’s traction
– D. Skeletal traction
MC
• Crutchfield traction and Halo vest-pins
inserted into the skull on either side is used
to:
– A. Reduce and immobilize clavicle fractures
– B. Reduce and immobilize fractures of the cervical
and high thoracic vertebrae
– C. Reduce and immobilize fractures of the lower
jaw
– D. Reduce and immobilize rib or sternal fx.
MR
• Skin traction differs from skeletal traction in
that the weights pull on some type of padding
attached to the skin below the site of the
fracture. Which of the follow would be
considered “skin traction”:
– A. Buck’s traction
– B. Russell’s traction
– C. Bryant’s traction
– D. External fixation device with weights
Other
• List 6 “important points” to remember when
caring for a patient in tractions:
MR
• Complications of traction include which of the
following:
– A. impaired circulation
– B. inadequate fracture alignment
– C. skin breakdown
– D. osteomyelitis
Other
• List 3 types of orthopedic devices related to
beds and a brief description of each.
MR
• Along with casts, this device is used to secure
the position of the body part being treated. It
can immobilize an area without surgical
intervention.
– A. crutches
– B. cane
– C. splint
– D. internal fixation
MC
• When using orthopedic devices for body part
support, the most significant safety feature is:
– A. proper application and use of each device
– B. Handing a brochure re: the device to the
patient to read when they get home
– C. Have the pt. watch a visual re: use of the
device
– D. Give the pt. information re: who to call with
follow up questions
MC
• Crutches increase mobility and assist with
ambulation. The proper fit for a pair of crutches
is:
– A. Pt. should be able to rest body weight comfortably
on the top of the crutches
– B. Crutches should be placed 1 foot in front of pts.
feet and 6 inches to each side for balance and
movement
– C. Top of crutches should be 3 inches below the axilla
to avoid pressure on the axilla and nerves
– D. Crutches can be placed wherever the pt. feels it is
most comfortable
MC
• When crutch walking, weight should be put
in/on:
– A. axilla
– B. unaffected extremity
– C. hand grips
– D. top of crutches
MC
• Hand grips should be adjusted so that the
elbow is flexed no more than _____ when
patient is standing in tripod position.
– A. 30 degrees
– B. 40 degrees
– C. 50 degrees
– D. 20 degrees
MR
• Walkers are used for support and balance. When
instructing a patient in use of a walker, the nurse
should remember which of the following to
teach:
– A. Push or lift the walker forward (depending on style)
– B. Legs are brought up to the walker
– C. May move both feet forward at once with modified
swing-gait move
– D. Encourage to lift head up and look forward not
down at floor
MR
• When instructing a patient in the use of a
cane, the nurse would teach the following:
– A. Place the cane on the unaffected side
– B. Advance the cane along with the affected side
– C. Look down at the floor or cane at all times
– D. one style of cane works for all clients
MC
• After joint replacement surgery, this machine
helps prevent scar tissue formation and
promotes flexibility. It is used at specific
intervals with defined parameters for
flexion/extension.
– A. Stryker rotation bed
– B. CPM machine
– C. ROM with pulleys and weights
– D. Circ-o-lectric bed