Anatomy & Physiology
What is the common diagnosis that requires a hip spica?
Hip Dysplasia
Does a patient need to be woken to assess NVO overnight?
YES, minimum 4/24
What is the percentage of ED admissions that are musculoskeletal injuries?
10-15%
Name 2 symptoms of possible appendicitis
Fever, N&V, localised tenderness, guarding, rebound tenderness, increased WBC & CRP, periumbilical pain migrating to RLQ – exacerbated by movement
How many hours post op with no void would be an indication to follow the POUR algorithm?
4hrs after transfer to PACU
What does ACL and MCL stand for?
ACL = Anterior cruciate ligament
MCL = Medical collateral ligament
What are the 5 P’s of Compartment syndrome?
Pain, Pallor, Pulselessness, Paralysis, Paraesthesia
What do the following acronyms stand for? POP, MUA, ORIF
POP: Plaster of Paris
MUA: Manipulation under anaesthetic
ORIF: Open reduction, internal fixation
How do you calculate a SFBC in a baby who does not have an IDC?
Pre weigh nappies. Once pt has PU weight the nappy and subtract nappy weight
When should a skin, pressure and falls assessment be completed? Provide 4 examples
On admission (within 2hrs), daily, change in condition, transfer from another ward, from theatres
What is the most common type of fracture in children?
Greenstick, buckle, physeal (involved growth plates) and avulsion (tenson/ligament pulls away a small piece of bone) fractures
What are the 3 A’s for the assessment of Compartment Syndrome?
Anxiety, Agitation, Analgesia
What is one major nursing care for a SUFE (Slipped Upper Femoral Epiphysis) pre-operatively?
Must remain non-weight bearing – may or may not include toilet privileges in a wheelchair.
Usually require an anti-rotation box pre and post-op to maintain appropriate leg positioning
What 4 things should you note about drainage (e.g. in a varivac drain)
Volume, colour, consistency, patency
1/24 readings
Any sudden rapid increase/decrease in colour or patency, report to the shift-co +/- team
How many teeth do primary/baby teeth have and how many teeth in permanent/adults (incl wisdom teeth)?
Baby = 20 (10 each arch)
Adult=32 (16 each arch)
What are 4 differences between child and adult bones?
Increased elasticity, thicker periosteum, increased vascularity, more porous, faster bone healing compared to adult bones
What are the 2 pulses of the foot called and where are they located?
Posterior Tibialis – found behind the inner ankle
Dorsalis Pedis – on the top of the foot
What is the purpose of overwrapping? When would this be conducted?
Post-Op: Patient’s have a backslab and crepe bandage insitu. This crepe bandage (1st layer) holds the backslab in place and should remain insitu until the f/u appt.
The x1 daily application of crepe (to be placed on then off, then reapply etc) aids in the trim/tightness of the backslab as swelling decreases.
These patients will then have an ortho clinic follow up1-2/52 for a TTT/T3 (trim, tidy and tighten) an all crepe (including 1st layer) is removed and a coloured coban is applied for an additional 6/52.
What is normal urine output for children and infants? AND is it the same for adolescents?
Child/infant = 1-2ml/kg/hr
Adolescent = 0.5 ml/kg/hr
How long can anaesthetic blocks last? And what discharge education would these patients receive?
Blocks can provide analgesia for roughly 12hours – the use of a block will be noted on the anaesthetic record
Altered sensation may be a result of a nerve block – good to keep in mind when conducting NVO
Education: Falls risk education. Simple analgesia at home for when the block wears off.
Define Compartment Syndrome – include the name of the tough membrane covering the tissue
Compartments: groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia, which keep the tissues in place and does not stretch or expand easily.
Compartment syndrome develops when swelling or bleeding occurs within a compartment. As the fascia does not stretch, this can cause increased pressure and reducing blood flow (oxygen and nutrients) to muscle and nerves, resulting in damage if left untreated.
In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome.
What is the normal compartment pressure in a child? (mmHg)
13 – 17 mmHg
In regards to Removal of Metal patients: How often should we perform NVO? Who would be considered an overnight case vs day case?
1x NVO. Use clinical judgement if there is a need to increase NVO
Day case = r/o metal from upper limb
Overnight = r/o metal from lower limb
Provide 5 examples of patients who require a SFBC
Deteriorating patient, complex abdo surgeries (with NGTs/Asp), infusions (IVT, TPN), epidurals, IDC, Drains, FTT/feeding difficulties, renal or cardiac history, burns patients, cleft lip/palate, cranial vault, trauma patients, flap or re-vasularisation, large orthopaedic cases (long OT times) e.g limb replacements
Provide 5 examples of risk factors for POUR?
Spinal/epidural, those on opioids, poorly controlled pain, history of urinary problems, surgery to pelvis, surgery that immobilises (spinal, lower limb – ortho), large volumes of IV fluids intraop, operation times greater than 2hrs