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ATI med surg- final unit 2024/2025 (100% verified)
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ATI med surg- final unit 2024/2025 (100% verified)
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ATI med surg- final unitWhat is arthroplasty? - ANSsurgical removal of a diseased joint due to OA, osteonecrosis,
RA, trauma, or congential anomalies, and replacing it with prosthetics or artificial
components made of metal and/or plastic
What is total joint arthroplasty? - ANSaka total joint replacement; involves replacement of all
components of an articulating joint
what is replaced in a total knee arthroplasty? - ANSdistal femoral component, tibia plate,
patellar button
what is replaced in a total hip arthroplasty? - ANSacetabular cup, femoral head, and femoral
stem
Preprocedure nursing actions for arthroplasty - ANSCBC, urinalysis, electrolytes, BUN, Cr-
rule out anemia, infection, organ failure
CXR- rule out pulmonary surgical complications
ECG- gather baseline rhythm to identify surgical contraindications (dysrhythmia)
evidence of incisional infection after arthroplasty - ANSfever, increased redness, swelling,
purulent drainage
Position of knee after TKA - ANSPlace one pillow under the lower calf and foot to cause a
slight extension of the knee joint and to prevent flexion contractures; the knee can also rest
flat on the bed; avoid knee gatch and pillow under the knee; positions of flexion are limited
due to flexion contractures
when is a CPM machine and when is it placed/used? - ANScontinuous passive motion
machine; usually placed and initiated immediately after surgery
following an arthroplasty, how often should you monitor neurovascular status of the surgical
extremity? - ANSq 2-4 hr
how to position client after hip arthroplasty - ANSPlace the client supine with the head
slightly elevated and the affected leg in a neutral position. Place a pillow or abduction device
between the legs when turning to the unaffected side
Do not cross legs!
Avoid flexion of hip >90 degrees!
2 major complications of hip arthro - ANSVenous thromboembolism- can develop into a DVT
resulting in a PE; monitor for manifestations (dyspnea, tachy, pleuritic chest pain)
,Hip dislocation, infection, anemia, neurovascular compromise- monitor for bleeding
osteoclast vs osteoblast - ANSosteoclasts- release calcium from the bone
osteoblasts- build up the bone
3 grades of an open fracture - ANSI: minimal skin damage
II: damage includes skin and muscle contusions but without extensive soft tissue injury
III: damage is excessive to skin, muscles, nerves, and blood vessels
complete vs. incomplete fracture - ANScomplete- goes through entire bone
incomplete- through part of bone
simple vs. comminuted fracture - ANSsimple- one fracture line
comminuted- multiple fracture lines splitting the bone into multiple pieces
displaced vs. non-displaced fracture - ANSdisplaced- has bone fragments that are not in
alignment
Non-displaced- has bnoe fragments that remain in alignment
fatigue (stress) fracture - ANSresults when excess strain occurs from recreational and
athletic activities
Pathological (spontaneous) fracture - ANSoccurs to bone that is weak from a disease
process, such as bone cancer or osteoporosis
Compression fracture - ANSoccurs from a loading force pressing on callus bone. this
condition is common in older adult clients who have osteoporosis
5 common types of fractures - ANS1. Comminuted- bone is fragmented
2. Oblique- fracture occurs at oblique angle and across bone
3. Spiral- fracture occurs from twisting motion (common with physical abuse)
4. Impacted- fractured bone is wedged inside opposite fractured fragment
5. Greenstick- fracture occurs on one side (cortex) but does not extend completely through
the bone (most often in CHILDREN)
, nursing care for a fracture - ANSelevate limb above heart, apply ice, assess for bleeding and
apply pressure if needed, cover open wounds with a sterile dressing, initiate and continue
neurovascular checks at least every hour
Closed reduction v.s. open reduction - ANSClosed reduction: a pulling force (traction) is
applied manually to realign the displaced fractured bone
Open reduction: surgical incision is made and the bone is manually aligned and kept in place
with plates and screws
frequency of neurovascular assessments throughout immobilization following a fractured
bone - ANSevery hour for the first 24 hr
every 1-4 hr therafter following initial trauma to monitor neurovascular compromise related to
edema and/or the immobilization device
What is included in a neurovascular assessment - ANS•Pain
•Sensation (numbess/tingling)
•Skin temp (extremity should be warm, NOT COOL, to touch. cool skin can indicate
decreased arterial perfusion)
•Cap refill
•Pulses- should be palpable and strong
•Movement- should be able to move affected extremity in active motion
Bryant's traction - ANScongenital hip dislocation in CHILDREN
Buck's traction - ANSused preoperatively for hip fractures for immobilization in ADULT
clients
Fat embolism - ANSusually occur withitn 12-48 hr following long bone fractures or with total
joint arthro
fat globules from the bone marrow are released into the vasculature and travel to the small
blood vessels, including those in the lungs, resulting in acute respiratory insufficiency and
impaired organ perfusion
what is a major difference between fat embolism and pulmonary embolism? - ANSIn fat
embolism, a late manifestation is *cutaneous petechiae* (pinpoint-sized subdermal
hemorrhages that occur on the neck, chest, upper arms, and abdomen- from blockage of the
capillaries by the fat globules)
manifestations of DVT - ANSswollen, reddened calf
fracture that has not healed within 6 months of injury is considered to be experiencing
__________ - ANSdelayed union
malunion vs nonunion - ANSMalunion: fracture heals incorrectly
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