All 155 of your review questions, grouped into 18 topics. The answer is hidden until you tap the question, so you can test yourself; Show all answers turns it back into a study guide.
Pain, Pallor, Pulselessness, Paresthesia (tingling/numbness), Paralysis, Poikilothermia (temp irregularity).
Severe pain, esp with passive stretching
Pulselessness
THIS IS AN EMERGENCY
A fasciotomy is an emergency surgical procedure in which the surgeon makes long incisions through the skin and fascia surrounding the affected muscle compartment.
The open wounds require sterile packing and dressing until secondary closure occurs. And when they do the secondary closure, they may need skin grafts and a negative pressure, la wound vac placed, just to keep that closed and reduce that edema.
FALSE
In most orthopedic injuries, you elevate the extremity above the level of the heart to reduce swelling. Compartment syndrome is the exception.
The problem in compartment syndrome isn't just swelling—it's loss of blood flow (perfusion) to the muscles and nerves.
Elevating above the heart decreases blood flow = worse!
Hourly for the first 24hrs. 1-4 hours after that.
Check the 6 Ps - risk for compartment syndrome
Pain, sensation, skin temp, cap refill, pulses, movement.
Distal neurovascular status (6 P's)
Respiratory distress, neurological changes, petechia rash
Fat embolism syndrome
Usually 24-72 hrs after long bone fracture.
Classic Triad:
Priority:
| Fat embolism | Pulmonary embolism |
|---|---|
| Long bone fracture | DVT |
| Petechiae | No petechiae |
| Neuro changes | Usually no neuro changes |
| 24-72 hrs after break | Anytime |
Late sign of FE - cutaneous petechiae. They're pinpoint-sized subdermal hemorrhages that can occur, usually in the neck, chest, upper arms, and abdomen, because of blockage of the capillaries by fat globules.
A. Clear mentation (normal mental status; Oriented x 4)
Fat embolus = dyspnea, respiratory distress, confusion because of lack of oxygen.
headache, and then ultimately a petechial rash
Open reduction Internal fixation (ORIF)
Delayed union
It can be treated with electrical bone stimulation and bone grafting. Low intensity pulse ultrasound can promote healing.
Never heals - nonunion
Heals incorrectly - Malunion
Break straight across the entire bone
Break at an angle across the bone
Greenstick - Most common in children because their bones are more flexible.
Think of trying to break a young green branch. It bends before it completely breaks—just like a child's bone.
Comminuted fracture
Often requires ORIF (plates, screws, rods). Higher risk for delayed healing.
Comminuted = Crumbled
"C" = Crushed into many pieces.
Spiral - Often occurs during sports injuries. In children, unexplained spiral fractures may raise concern for abuse.
Compression - Common in vertebrae due to osteoporosis. May cause sudden back pain and loss of height.
Impacted - Often occurs with falls, especially hip fractures in older adults.
Impacted = In
One bone fragment is driven into the other.
Pathologic - Common causes include osteoporosis, bone tumors, or metastatic cancer.
Osteoporosis
Open because of actual exposure through the compromised skin.
For open fractures: Prevent infection. Cover with a sterile dressing, administer IV antibiotics, assess tetanus status, and prepare for surgery.
With the palms NOT the fingers (this is for plaster casts which take a long time to dry (24-72hrs) and fingers can leave indents.
Fiberglass is more common now - dries in 30min. More water proof (don't need as much water proofing)
Elevate!
False - allow for some swelling to go down to avoid compartment syndrome (swelling causes diminished blood flow = necrosis)
Prevent soft tissue injury; Maintain alignment, reduce muscle spasms, dec pain
No
Only changed by a provider, NOT patient
Screws are inserted into the bone
Can use heavier weights (15-30lbs) and longer traction times to realign bones.
Pin site care is key.
A. Maintain alignment - helps to heal.
Assess traction for proper weight alignment every shift.
Patient should use an incentive spirometer regularly to avoid atelectasis/pneumonia.
External fixation
Internal fixation uses plates, screws, pins, and rods inside the body (open reduction)
A. I will avoid getting the cast wet
DEXA scan
<= -2.5
Normally, specialized cells called osteoclasts break down old bone (bone resorption). In osteoporosis, bone is broken down faster than it is rebuilt.
Hip, vertebra, wrist
Low calcium and Vit D
Sedentary lifestyle
Smoking and excessive alc
Low body weight or eating d/o
Certain meds (corticosteroids, anticonvulsants)
"Biscuits and Ale to Rise"
Alendronate (Fosamax) is a bisphosphonate that is primarily used to prevent and treat osteoporosis by slowing the breakdown of bone.
Take in the morning on empty stomach
Full Glass of water (not coffee, tea)
Remain upright for 30-60 mins - Can cause severe esophageal irritation.
Decreases bone resorption
Used to treat osteoporosis and reduce fracture risk.
Watch for osteonecrosis of the jaw and advise good dental care.
Weight-bearing exercises
Also Vitamin D with calcium supplementation
Monitor bone mineral density (stop calcium before test) and ability to perform ADLs.
| Osteoporosis | Osteoarthritis |
|---|---|
| Bone density loss | Cartilage degeneration |
| Usually painless 'til fracture | Joint pain |
| DEXA diagnosis | X-ray |
| Fractures | Stiffness |
Degeneration of articular cartilage (wear and tear) on weight-bearing joints
Diagnostics: X-ray
Treatment: Exercise, weight loss, heat, NSAIDs, arthroplasty/replacement if severe
Knobby Joints
Pain worse with activity
Morning stiffness <30 minutes
Crepitus (cracking, popping in joints)
Limited ROM
Analgesics, like Tylenol, topicals, lidocaine patches, NSAIDs (ibuprofen, naproxen) for pain relief
Opioids - tramadol is a weak opioid that can be used.
Hot/heating pads - but not too hot.
Cold packs
Intra-articular injections of glucocorticoids (localized inflammation) or hyaluronic acid replacement.
Total joint arthroplasty/replacement
Arthroplasty (partial or total joint replacement)
RA is a chronic autoimmune disease that causes symmetrical inflammation of the synovial joints, resulting in progressive joint damage, pain, stiffness, and loss of function.
| Rheumatoid arthritis | Osteoarthritis |
|---|---|
| Autoimmune | Wear and tear |
| Any age | Usually older age |
| Morning stiffness >1 hour, improves with movement | Worse with movement |
| Starts in small joints | Weight-bearing joints |
| Usually bilateral / symmetrical | Asymmetrical |
| Can cause deformities | Typically doesn't |
| Systemic symptoms | Localized |
Osteoarthritis
Maximum of 90 degrees. Don't bend over to the ground.
After hip surgery to prevent hip dislocation.
Fever, redness, drainage
| Knee | Hip |
|---|---|
| Early ROM | No flexion > 90 |
| CPM machine | No crossing legs |
| Knee exercises | Abduction pillow (avoid dislocation) |
Prevent dislocation of that new joint.
Neurovascular compromise
DVT/PE
Infection
Bleeding
A. Clean the incision daily with soap and water
C. Sit in a straight-backed chair
E. Use a raised toilet seat. (Don't excessively bend at hip)
C. Reduce the amount of exercise done on days you have increased pain (Don't stop exercises, just reduce # of reps)
E. Active range of motion is more effective than passive.
Severe Localized Bone Pain ⭐ pulsating, worse with movement.
Open fracture
Orthopedic Surgery
Diabetic Foot Ulcers
Bloodstream Infection
Bed rest/immobilization
Weight-bearing is avoided (weak bones)
Elevate the injured area
A. Antibiotic therapy should continue for 3 months - these are hard to heal.
Avascular Necrosis
Severe chronic pain that usually follows a musculoskeletal trauma.
It's more common in the feet and in the hands.
It can develop if acute pain is not well managed.
CRPS
Avoid taking blood pressures, IV starts, blood draws in that affected extremity because we don't want to cause more pain
It is a real thing - pain perceived in an amputated limb.
Pain meds (Gaba)
Mirror therapy
Desensitization
True - Prone positioning prevents amputation contractures.
They should also avoid prolonged knee flexion.
False
The strong side
Cane - weak leg - strong leg
Walker - weak leg - strong leg
** Never pull walker toward body.
On the hands, not the axillae (armpits)
2-3 finger width below axilla
Weight in hands, not armpits
Three point gait
Move:
Both crutches + injured leg
Then good leg
4-point
Slowest, most stable, both legs bear weight.
Up with the good, down with the bad
Up:
Good leg - Crutches - Bad leg
Down:
Crutches - Bad leg - Good leg
DVT, venous stasis, orthostatic hypotension
Atelectasis, pneumonia, retained secretions
Muscle atrophy, contractures, bone loss
Reposition every 2 hours
Bowel/bladder dysfunction
Saddle Anesthesia
Progressive weakness
Fever or Hx of cancer
Saddle anesthesia is a loss or decrease of sensation (numbness) in the areas of the body that would touch a saddle if you were sitting on a horse.
This includes the:
Perineum
Inner thighs
Buttocks
Genital area
Think of the area that contacts a bicycle or horse saddle.
It is when a needle removes synovial fluid.
Used to diagnose:
MRI
Ligaments, Tendons, Cartilage, Spinal cord, Meniscus
Can't use with: Pacemakers, cochlear implants, certain aneurysm clips, metal frags
Complex fractures
Joint and spine injuries
May use contrast - confirm iodine allergy, kidney function (BUN/Creatinine) - hydrate after
Small camera inserted into the joint to diagnose:
Torn meniscus
ACL injury
Cartilage damage
Post-op:
· Ice
· Elevation
· Neurovascular checks
Watch for infection
Measures muscle electrical activity.
Used for:
· ALS
· Muscular dystrophy
· Peripheral neuropathy
Before test - Avoid caffeine.
After - Temporary soreness expected.
Used to diagnose:
Osteomyelitis
Bone tumors
Complications: Bleeding and infection.
*** Check PT/INR and platelets before procedure for bleeding risks
O - Onset - when did it start
L - Location - where is the pain
D - Duration - how long does it last, constant/intermittent
C - Characteristics - What does it feel like (sharp, dull, burn)
A - Aggravating/alleviating factors
R - Radiation - does it travel anywhere
T - Timing - Does it occur at certain times? Has it changed over time
S - Severity - 0-10
NSAIDs + OTCs
Opioids
hot/cold
Tylenol (Not biliary, liver d/s)
Lidocaine
Kidney disease/Fluid Volume issues
Heart failure = retaining fluids
Respiratory issues = fluid worsens lung issues
GI bleeds/Ulcers
Opioids/Morphine (assess respiratory first)
Need more info before doing the other things.
"Best Sort-of Malignant"
Basal Cell Carcinoma - low chance of metastasizing.
Squamous Cell Carcinoma - Mid-risk. Can become Melanoma
Malignant Melanoma - High risk of metastasizing
A - Asymmetry
B - Border - jagged, scalloped, notched
C - Color - Multiple or uneven pigment
D - Diameter (>6mm, pencil eraser)
E - Evolution - changes over time
C. This cancer rarely metastasizes but requires complete removal
D. Distributing free sunscreen samples with application instructions. PRIMARY PREVENTION
A, B, and C are all Secondary - finding/screening/reducing effects of existing issues.
Tertiary is dealing with folks who have had something and want to avoid it again or lessen impact of ongoing issues.
During admission
Timeout
Right operation, right patient, right location.
Circulating nurse advocates for the patient during the operation.
Bleeding, atelectasis, pain control, DVTs, infection control (incision), GI motility (early ambulation)
A. Ensure overall client safety and act as client advocate
When a patient has dysphagia (trouble swallowing) they will often hold/store food in their mouths, which ends up in the pockets of their cheeks.
Acute respiratory failure (ARF)
True
A patient may have a cough, pleuritic-type chest pain, and dyspnea, whereas somebody who is older may have the initial clinical manifestation of confusion.
Deep breathing, incentive spirometry
D. Suctioning PRN using a specialized endotracheal suction tube
A. Tachycardia = inc HR to compensate for low O2
B. Tachypnea
C. Pleuritic chest pain = sharp, worsens with inspiration, usually on affected side
D. Tracheal deviation (esp with tension pneumo)
Obesity >29 BMI (not 20)
Estrogen = PE (post-meno doesn't have estrogen unless on HRT).
ARDS = diffuse alveolar injury (ventilation issue) direct or indirect lung injury.
Education: Explain the why behind the isolation, how long it will last (3 negative sputum cultures)
Lasts at least 6-12 months
Must adhere and complete all med cycles
Many TB drugs are hepatotoxic.
R - Rifampin - Orange-red body fluids, hepatotoxicity
I - Isoniazid (INH) - Peripheral neuropathy, hepatotoxicity
P - Pyrazinamide - Hepatotoxicity, hyperuricemia (gout)
E - Ethambutol - Optic neuritis (vision changes)
Loud snoring, daytime sleepiness
TX: CPAP
Tremors (jittery, shaky)
Palpitations
Agitation
Tachycardia, restlessness, nervousness
Using a Metered-dose inhaler.
Tiotropium is a long-acting anticholinergic medication. It is typically administered by dry powder inhaler, not metered dose inhaler.
Avoid triggers - pollen (stay indoors during high pollen days); smoke
Using a rescue inhaler before exercising can prevent an exercise-induced bronchospasm, but it is not a comprehensive strategy for preventing overall asthma exacerbations.
A. SpO₂ 90% - Hypoxemia is a key indicator
C. Bilateral wheezing - classic sound
D. Tachypnea - Increase R/R to compensate
E. Accessory muscle use
F. Confusion - Altered mental status (restlessness, confusion, or lethargy) is a late and serious sign
B. "I will use my short-acting bronchodilator before engaging in physical activity."
SABAs such as albuterol are used both as rescue medication for acute symptoms and prophylactically before exercise or other activities that may trigger dyspnea.
Take bronchodilators FIRST, before corticosteroids to allow for better absorption.
The Venturi mask is actually the preferred device when a precise oxygen concentration is needed for COPD patients.
Avoid high-flow oxygen - it can depress respiratory drive
Hypoventilation = CO2 retention = Low pH
(The more I hold my breath, the more acidic I become)
Hyperventilation → CO₂ loss → ↑ pH
Think: "Blowing off too much CO₂."
Anxiety/panic attack
Pain & Fever (inc r/r)
Early sepsis
PE
Respiratory Alkalosis = "Breathing Too Fast."
"The body is making acid or losing base."
** Kussmaul respirations (deep, rapid)
Metabolic Acidosis = "Diarrhea and DKA."
Too much bicarbonate OR loss of stomach acid
Metabolic Alkalosis (loss of too much acid)
Respiratory Acidosis = "Not Breathing"
😴 Sleepy
🧠 Confused
🤕 Headache
🌬️ Breathing too little
📈 High CO₂
High CO₂ = CNS Depression
Resp Acidosis caused by hypoventilation (holding onto CO2)
Compensation = increased renal retention of bicarb (inc HCO3 to up the base, up the pH).
Kussmaul respirations are deep, rapid, labored breathing that occurs as the body tries to compensate for metabolic acidosis.
The patient is trying to blow off CO₂ to reduce the acidity of the blood.
Seen a lot in clients with DKA (high ketones = high acid)
Confusion and seizures - neurological systems
Tall peaked T-waves, muscle cramps
Potassium = heart and muscles
Tetany and positive Chvostek's sign
Depressed tendon reflexes
(Think - you take Mg to go to sleep and to poop b/c it relaxes your muscles. So too much = too much relaxation.)
Hypertonic (high Na) = > 0.9% saline
So 3% normal saline would work.
They need more salt, give them hypertonic.
However, this does NOT cure FVD. Only to fix the electrolyte issue b/c it pulls water from cells.
Hypotonic turns your cells into hippos - fat cells = rehydration. Na is high (170). Give them 0.45% saline.
Isotonic solutions.
0.9% saline or Lactated Ringers
Ex: low blood pressure due to fluid volume deficits
It's a Potassium-sparing diuretic - so look for hyperkalemia (muscle cramps, peaked T-waves, widened QRS intervals)
Loop diuretics (Furosemide) and Thiazides do NOT spare K+, so look for hypoK.
Lisinopril - PRILs
ACE inhibitors → Hold on to potassium → Risk of hyperkalemia.
So when you see Lisinopril + spironolactone = Hyperkalemia risk.
They block the RAAS system so no aldosterone (which normally causes retention of water and Na, and excretion of K+). No RAAS, no aldosterone, no K+ excretion.
Hyperkalemia - kidneys can't excrete
Peaked T-waves
Fluid volume overload (crackles, edema)
TX: Diuretics (loop), Calcium gluconate IV to stabilize cardiac membrane, IV regular insulin and D50 (drive K+ back into cells), or sodium polystyrene sulfonate (pulls K+ into bowels)