Intervention
Explain the rational behind skin preparation in preoperative management.
↓ risk of infection
We know that vitamin D increases calcium absorption; what are three ways to increase vitamin D?
Nutritional uptake (fatty fish, dairy, egg yolks), brief sunlight exposure, and supplementation
SATA: In preparation for post-op care, which of the following will you include in patient education? Explain rationale.
a) The procedure of the surgery
b) Deep breathing exercises
c) Coping techniques
d) Quadricep setting exercises
b) Deep breathing exercises - prevents atelectasis
c) Coping techniques - helps decrease stress; catecholamines mobilize fatty acids which cause fat globules to be in the blood stream
d) Quadricep setting exercises - improves stability of the knee
What interventions can be used to prevent contractures?
Thermotherapy, especially heat, may reduce muscle spasms
SATA: During post-op care of an orthopedic patient, which following assessment findings would you be most concerned with?
a) Patient in the tripod position
b) Petechiae
c) Reddened, watery serous drainage
d) Restlessness
a) Patient in the tripod position - sign of dyspnea; could be fat embolism
b) Petechiae - occurs around the chest with pulmonary embolus r/t fat embolism syndrome
d) Restlessness - sign of fat embolism, hypoxia
Your patient is at risk for peripheral neurovascular dysfunction related to vascular insufficiency and nerve compression secondary to edema and medical compression of a splint. What is the priority nursing intervention?
a. perform a comprehensive neurological assessment Q4h and PRN
b. perform a comprehensive peripheral vascular assessment Q4h and PRN
c. teach patient and caregivers the importance of reporting S&S of changing neurovascular status immediately
d. prevent infection in wounds
b. perform a comprehensive peripheral vascular assessment Q4h and PRN
Compartment syndrome can lead to this procedure?
Amputation - compartment syndrome compromises the function of blood vessels, nerves, and tendons and can end up compromising tissue viability
SATA: During pre-op care, prior to administering ancef, the patient asks why they need an antibiotic if they are in the hospital for a fracture. How will you respond? Explain rationale.
a) To decrease the risk of developing clostridium difficile
b) To decrease the risk of developing osteomyelitis
c) To decrease the risk of developing an infection r/t to a pressure ulcer
d) To decrease the risk of surgical site infections
b) To decrease the risk of developing osteomyelitis
d) To decrease the risk of surgical site infections
A patient complains of a painful swelling in her right thigh. A pain assessment has been completed, and the prescribed analgesics have been administered. However, the patient still reports pain, what is your next step?
a. notify physician if measures to relieve pain are unsuccessful, or if current pain is a significant change from the pt’s past experience of pain
b. educate pt. on non-pharmacological techniques
c. reassess pain using PQRSTU
d. elevate and support leg, apply ice (if prescribed)
c. reassess pain using PQRSTU
Your patient reports that they are feeling numbness and pain in the affected extremity. They present pale skin and no peripheral pulses. Based on this assessment, what do you think could be happening?
Compartment syndrome - they are presenting pain, paresthesia, pallor, and pulselessness, which are 4 of the 6 P's (manifestations of compartment syndrome)
SATA: During post-op care, which of the following findings should you inform your doctor about with regards to your patient who has a fractured femur? Explain rationale.
BONUS: what would you recommend (answer in SBAR)
a) A respiration rate of 28 and a heart rate of 147
b) A SPO2 of 92%
c) WBC count of 21 x 10^9/L
d) Cool, pale, increasingly painful and tingling toes of the affected leg
a) A respiration rate of 28 and a heart rate of 147 - signs of hypoxemia r/t fat embolism syndrome
c) WBC count of 21 x 10^9/L - may be osteomyelitis or just general infection r/t surgical wound
d) Cool, pale, increasingly painful and tingling toes of the affected leg - compartment syndrome
Which of the following interventions does NOT help decrease the rapid deconditioning of the cardiopulmonary system?
a. passive/assisted ROM
b. standing transfers
c. helping pt. sit on side of bed, legs dangling
a. active/passive ROM
Your patient presents a skin colour change, ST wave changes, and decreased platelet levels. Based on this, what do you suspect is going on?
Fat embolism syndrome - fat globules distributed into tissues and organs after a traumatic skeletal injury
SATA: Which of the following doctor's orders will you question during pre-operative care with a patient who has a fractured femur and the comorbidity of diabetes? Explain rationale.
a) Bladder scan PRN, in and out catheter if the bladder scan shows <100 mL
b) Medication order of cefazolin sodium
c) Medication order fo clopidogrel
d) Hold basal insulin as the patient is on NPO status
e) Weight bear on leg once a day
a) Bladder scan PRN, in and out catheter if the bladder scan shows <100 mL - you would check urinary output first ; <100 mL is generally good
c) Medication order fo clopidogrel - prior to surgery, you would stop any blood thinners to prevent hemorrhaging
d) Hold basal insulin as the patient is on NPO status - patients should receive their insulin as they usually experience high levels of stress = increased blood glucose
e) Weight bear on leg once a day - they should be moved as little as possible because the fat droplets could get dislodged into general circulation and can cause acute respiratory distress syndrome