Ortho Exam, Principles of Surgery/Anesthesia – Flashcards
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pain, deformity, decreased ROM
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specific complaints in patient history
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acute, chronic
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name the chronological sequences of orthopedics
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static, progressive, improving
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progression of symptoms in orthopedics
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constant vs intermittent, radiation of pain
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description of symptoms
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evaluate globally, then specifically
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how should you approach the evaluation process in orthopedics?
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-posture, alignment, deformities, and relationships -body attitude when sitting and standing -carriage of body when walking -body mechanics
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general orthopedic examination
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-examine opposite side first, then joint above and below -inspection for deformity, swelling, coloration, and overlying skin defects -ROM -palpation -joint position -measurements -neurological exam -vascular assessment -specific diagnostic studies
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specific orthopedic examination
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point tenderness, swelling, spasm, temperature, deformity, crepitus
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what are you looking for during palpation?
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position of function vs position of comfort -if joint is allowed to become stiff in a position of comfort, disability is markedly magnified
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what to look for in joint position
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peripheral vs. CNS
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What are you trying to determine in a neurologic exam?
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-vascular injuries, -compartment syndrome, -leg pain vs. claudication, -pre-op evaluation
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4 things to look for in vascular assessment
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-pain, -pallor -parasthesia, -paralysis, -pulselessness
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5 P's of compartment syndrome
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injecting a radiopaque dye into the joint spaces to view effusion
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describe an arthrogram
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x-ray of the spinal cord obtained after intraspinal injection of contrast medium
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describe a myelogram
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a device used to produce a radiographic image on a flourescent screen for visual examination of internal structures in motion in real time
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describe a flouroscope
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complaints of a systemic nature
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Why would an orthopedist to examine c-reactive protein or erythrocyte sedimentation rate?
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inflammatory, malignancy, rheumatologic disorders
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What 3 causes do examine c-reactive protein or erythrocyte sedimentation rate investigate?
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If the patient has a systemic complaint, and c-reactive protein/ESR are negative
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Why would an orthopedist to look at complete blood count?
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Reveals info about anemia/infection. general indication of patient's health.
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what does complete blood count tell the physician?
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If the patient has a systemic complaint. If c-reactive protein, ESR, and complete blood count are negative.
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Why would an orthopedist look do a synovial fluid analysis?
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cell count, crystals, cultures
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What is measured in a synovial fluid analysis?
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-bones and joints have a lower resistance to infection. -inflammatory process is slower in bones and joints, -infections of bones and joints are more difficult to treat
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Why is orthopedic antiseptic technique more intense than general surgery?
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-not common. 1/200,000. Can be devastating though.
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Anesthesia complications frequency
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-nerve damage, - headaches from spinal anesthetics, -aspiration, -cardiac problems
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Describe complications of anesthesia in surgery
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any surgery of a joint has the potential to damage cartilage and cause arthritis
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Describe complications of arthritis in surgery
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patients can lose an unexpected amount of blood during a surgery.
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Describe complications of blood loss in surgery
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stop taking NSAIDS 2 weeks before surgery.
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What is a way to prevent blood loss complications?
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blood donation
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What is a way to remedy blood loss complications?
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Surgery can put an unusual strain on vessels, causing damage. Long term: May become calcified.
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Describe the complications of vessel damage in surgery. (and long term risk)
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DVT is a common complication of an orthopedic surgery
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Describe the frequency of complications of DVT in surgery
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40-60% of ortho surgeries
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incidence of DVT if not receiving thromboprophylaxis
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.3%
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incidence of pulmonary embolism in a surgery
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procedures like TKA, THA, TSA, involve a significant risk of fracture due to the rough nature of the surgeries
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Describe the complications of fracture in a routine orthopedic surgery
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arthrosope: near 0. Open fracture: several percent.
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Describe risk of infection in an arthroscopy vs. open fracture
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procedures involving screws/plates require a second procedure. The physician cannot guarantee a Union of bones
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Describe the risk of loss of reduction/ non-union in surgery
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smoking, poor blood supply
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risk factors for non-union of fracture
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some surgeries are guaranteed some nerve damage, though minor. Others have unintended side effects of nerve damage
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describe the risk of nerve damage in a surgery
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medial parapatellar incisions. Associated with numbness due to laceration of infrapatellar branch of saphenous nerve
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name a procedure that is associated with nerve damage, and describe effects
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-history/physical exam. medical condition condition of skin-infection, contamination neurovascular status
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Describe patient prep before a surgery (days before)
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-Lab work, -no shaving extremity, -betadine scrubs.
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Describe patient prep before a surgery (night before)
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-position to allow access and avoid nerve palsies, -antibiotics, -tourniquet, -pre-op shave, -catheter for long procedures
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Describe patient prep before a surgery (day of)
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-hand scrub 10 mins, -betadine or hibeclens, -antibacterial lotion, -gown, gloves, isolation suits.
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Surgeon prep before surgery
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Skin cleanser used to reduce bacteria that potentially can cause skin infection. Appears brown in color when applied to the skin.
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betadine
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skin cleanser
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hibeclens
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-position instruments and implants, -laminar air flow, -limit access
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room prep before surgery
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-personnel, -patient draping
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Surgical field prep before surgery
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-longitudinal, -langer lines, -z-plasty, -y-shaped, -t-shaped
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Name incision types
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-avoid major neurovascular bundles, -allow proximal/distal extension
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benefits of longitudinal incisions
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may be cosmetically less appealing
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disadvantages of longitudinal incisions
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normal tension lines of the skin, used to define direction of the scar
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langer lines
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between 2 muscles with different nerve supplies is safest dissection plane, avoids denervation of muscles
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internervous
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between 2 muscles that are supplies by the same nerve; can denervate muscle if too proximal near muscle origin
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intermuscular
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muscle splitting
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likely to denervate part of the muscle
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-pre-op planning, -intra-op adaptation, -intra-op cultures, -hemostasis: arrest of bleeding -antibiotic irrigation
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What are the factors that determine outcome of surgery?
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primary, delayed primary, healing by secondary intention
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name the 3 types of wound closures
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closed by surgeon immediately
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primary wound closure
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allowed to drain, clear, then close
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delayed primary wound closure
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wound heals from inside out
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healing by secondary intention
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-suture, -staple, -glue
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materials used to close wounds
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-positioned with ice, -protect tissues, -immobilization, restricted ROM, WB status
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post-op positioning and precautions
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daily
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how often are dressings changed after an ortho surgery?
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24-48 hours
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when are hemovac drains removed?
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. alveolar collapse. post op day 3 fever
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atelectasis (describe, and what day)
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post-op day 4-6
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UTI (what day)
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post-op day 7-10
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wound infections and DVT (what day)
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-immobilization, -lower extremity pelvic surgery in the last 4 weeks, -history of previous DVT, -history of cancer
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risk factors for DVT
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-swelling, -decreases pulses, -Homan's sign (50% of the time)
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signs/symptoms of DVT
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Blockage of the pulmonary artery by foreign matter or by a blood clot
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pulmonary embolism
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-age, -weight, -varicose veins, -immobility, -smoking, -previous DVT, -joint replacement, -estrogen therapy
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risk factors for pulmonary embolism
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-SOB, -chest pain, -cough, -lung sounds
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signs/symptoms of pulmonary embolism
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7-14 days
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how long do staples and stitches stay in?
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3 weeks
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how long do staples and stitches stay in if the pt is on steroids or has DM?
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when skin is healed (but this varies from surgeon to surgeon)
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when are Pt's allowed to shower and bathe again following surgery?
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drug-induced CNS depression
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anesthesia definition
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-inhalation, -IV, -balanced (components of both)
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3 ways to administer general anesthesia
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-high spinal, -spinal headache, -allergic response, -anaphylactic shock, -seizures, -nausea and vomiting
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complications of anesthesia
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-topical, -regional nerve block, -IV block, -spinal anesthesia
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types of regional anesthesia
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decrease pain immediately post-op
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purpose of nerve block
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-shoulder, -axilla, -wrist, -fingers/toes, -femoral nerve, -ankle
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areas that can receive regional nerve block
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-epidural, -subarachnoid
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name the 2 types of spinal anesthesia
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-to avoid general anesthesia, -reduce side effects of general anesthesia, -decrease pain after surgery, -preform ROM activities
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reasons to use regional anesthesia
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-nerve injury due to direct trauma, -prolonged sensorimotor block, -local bleeding/hematoma, -systemic reaction
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complications of regional anesthesia
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