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Questions and Answers
What is the primary function of ligaments in the skeletal system?
Which bone tissue is primarily found at the ends of long bones and contains red bone marrow?
What is the correct order of instruments used to fixate a bone after a fracture?
Which of the following statements about bone grafts is true?
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What is the role of the periosteum in relation to bone tissue?
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Which type of graft requires stabilization with orthopedic hardware?
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Which structure separates the epiphysis from the diaphysis in long bones?
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What is the primary role of the Synovial Membrane in the joints?
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What is a key characteristic of the Intra Capsular Cataract Extraction (ICCE) procedure?
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Which of the following ethical values emphasizes maintaining commitments in perioperative nursing?
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Which statement about mydriatics is accurate?
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What precaution is essential when using lasers in ophthalmology?
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Which of the following best describes the 'Recession' procedure in strabismus repair?
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What is the primary purpose of using pneumatic tourniquets during extremity procedures?
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Which statement correctly describes the handling of prosthesis in the operating room?
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What should be done if a powered surgical instrument drill is handed to a surgeon?
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What is the maximum recommended inflation pressure for a pneumatic tourniquet on a thigh?
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When performing external fixation, which benefit is most significant compared to closed reduction?
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Which component mixed with methyl monomer yields polymethylmethacrylate (PMMA) cement?
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What is the main goal of fracture surgery?
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Which of these procedures does NOT utilize an external fixation approach?
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For intertrochanteric fractures in elderly women, which fixation method is most appropriate?
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What must be documented for each surgical implant used?
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What is the purpose of inserting a guide pin during the fixation of hip fractures?
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What typically differentiates a stable femoral neck fracture from an unstable one?
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During total hip arthroplasty, when is lead gown protection not required?
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What is the gold standard method for treating subtrochanteric fractures?
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What is a common treatment included in the repair of knee injuries during arthroscopy?
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Why is it important to select the correct sided implant during total knee arthroplasty?
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What role do the collateral ligaments play in knee function?
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What is a common type of graft used in anterior cruciate ligament repair?
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What type of irrigation fluid is typically used during knee arthroscopy?
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What effect does a compromised blood supply have on femoral neck fractures?
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What is the primary indication for a tympanoplasty?
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Which surgical procedure requires a tracheostomy prior to completion?
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What is the primary purpose of using Mayfield head fixation devices in neurosurgery?
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Which type of skin graft involves the severing of the original blood supply and reattaching it to a recipient site?
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What is a critical consideration for managing burn surgeries regarding the surgical environment?
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What is the main goal of the dressing in burn surgery?
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Which instrument is specifically used for hemostasis in scalp surgery?
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What is a characteristic feature of Full Thickness Skin Grafts (FTSG)?
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During neurosurgery, what type of count is particularly significant when closing the dura mater?
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Which of the following is NOT a common positioning for neurosurgery?
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Study Notes
Anatomy Overview
- Muscles: Tissues covering bones, enabling skeletal movement.
- Ligaments: Connective tissue bands providing stability by holding bones together.
- Tendons: Connect muscle to bone or cartilage, transmitting force.
- Cartilage: Elastic tissue at bone ends, providing support and stability.
- Joints: Connections between bones allowing movement.
Bone Tissue and Blood Supply
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Types of Bone Tissue:
- Cortical Bone: Hard outer shell supporting tissue.
- Cancellous Bone: Soft, spongy inside, contains red marrow, found in various bones like the iliac crest and tibia.
- Long Bones: Comprised of a diaphysis (shaft) and two epiphyses (ends), containing cancellous bone.
- Epiphyseal Plate: Cartilage separating epiphysis from diaphysis, present until maturity.
- Periosteum: Covers bones, crucial for repair processes, stripped away for fracture handling.
Surgical Procedures
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Instruments for Bone Fixation:
- Bone holder, drill, tap, depth gauge, screwdriver.
- Minor Count: Conducted for all orthopedic cases (initial, closing, final).
Bone Grafts
- Purpose: Fill cavities after bone removal, promote fracture healing.
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Types:
- Allograft: Bone from a tissue bank.
- Autograft: Bone harvested from the patient, primarily from the iliac crest.
- Instrumentation: Involves osteotome, mallet, and bone curette.
Equipment and Nursing Considerations
- Powered Surgical Instruments: Must be secured and tested before use; safety procedures to prevent accidental activation.
- Operating Room Tables: Specific tables for femoral and spinal surgeries; have protocols for emergencies.
- Radiography: C-Arm for imaging during procedures, required protective gear (lead gowns).
Pneumatic Tourniquets
- Purpose: Facilitate bloodless surgical field for extremity procedures.
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Pressure Guidelines:
- Arms: 250-300 mmHg
- Thighs: 300-350 mmHg
- Time Limitations: Upper extremities ≤ 60 minutes, lower ≤ 120 minutes.
Bone Cement (PMMA)
- Composition: Barium sulfate powder mixed with methyl monomer liquid; radiopaque for imaging.
- Safety Measures: Proper ventilation required, special equipment minimizes fume exposure.
Medications
- Bacitracin: Mixed with saline for bone/tissue irrigation.
Handling Prostheses
- Protocol: Meticulous handling to avoid damage; inspection and documentation of implant information.
Orthopedic Surgery Causes and Procedures
- Fracture Overview: Break in bone continuity due to trauma or disease (e.g., osteoporosis).
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Common Procedures:
- Closed Reduction: Non-surgical method to align fragments.
- External Fixation: Stabilizes fractures while allowing management of soft tissue injuries.
- ORIF: Internal fixation with direct exposure of fractures.
Hip Fracture Types and Fixation
- Intertrochanteric Fractures: Common in elderly; fixated using Dynamic Hip Screw instrumentation.
- Femoral Neck Fractures: Require reduction and internal fixation to prevent complications.
Total Hip Arthroplasty (THA)
- Types: Unipolar and bipolar components; aims for symmetrical limb alignment in bilateral replacements.
Total Knee Arthroplasty (TKA)
- Indication: For arthritic conditions to restore joint function.
- Prosthesis Types: Left and Right specific; goal to maintain knee motion.
Basic Anatomy
- Middle Ear Components: Tympanic membrane, Eustachian tube, ossicles.
- Thyroid & Parathyroid: Hormonal regulation and calcium homeostasis.
Surgical Considerations
- Facial Nerve Monitoring: Important in rhinologic and laryngeal surgeries.
- Tympanoplasty: Repair and reconstruction to treat conductive hearing loss.
- Functional Endoscopic Sinus Surgery (FESS): Aims to improve sinus drainage.
Neurosurgery
- Dissection Layers: Involves careful skin incision, galea dissection, burr hole creation.
- Instruments: Include Raney clips, neuro patties, bone wax, and sutures.
Plastic Surgery Techniques
- Dermatomes & Skin Meshers: For skin graft harvesting and expansion.
- Flaps: Pedicle and free flaps for reconstructive surgeries.
Burn Surgery
- Environment: Maintain a warm surgical room to prevent hypothermia.
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Graft Types:
- Split Thickness Skin Graft (STSG): Rapid healing, potential for contractures.
- Full Thickness Skin Graft (FTSG): Minimized contracture risk, primarily closed with sutures.### Cataracts
- Clouding occurs in the lens of the eye, which is normally clear.
Cataract Surgery
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Cataract Extraction: Removal of opaque lens using various methods.
- Extra Capsular Cataract Extraction (ECCE): Rupture of the anterior capsule, removal of lens cortex and nucleus using phacoemulsification, leaving posterior capsule intact.
- Intra Capsular Cataract Extraction (ICCE): Removal of the lens within its capsule using a cryoprobe, rarely performed, mainly for dislocated lenses.
Strabismus
- Ocular misalignment due to neuromuscular eye movement issues, often seen in children but can persist into adulthood.
- Four categories:
- Esotropia: Inward turning of one or both eyes.
- Exotropia: Outward turning of one or both eyes.
- Hypertropia: One eye positioned higher than the other.
- Hypotropia: One eye positioned lower than the other.
- Repair Methods:
- Recession: Muscle cut and reattached further back to weaken it.
- Resection: A segment of muscle removed, and the shortened muscle reattached to strengthen it.
Medications
- Mydriatrics: Dilate the pupil for focusing.
- Cycloplegics: Dilate the pupil while inhibiting focusing.
- Miotics: Constrict the pupil.
- Viscoelastics: Lubricate and support the eye.
- Viscoadherents: Maintain chamber stability.
- Irrigants: Provide moisture, e.g., Balanced Salt Solution (BSS).
- Hyperosmotics: Lower intraocular pressure.
Laser Precautions
- Eye Protection: Use goggles and eye pads designed to protect against specific wavelengths, with side shields and regular inspections.
- Controlled Access: Limit entry to authorized personnel, use warning signs, and keep doors closed.
- Fire Safety: Annual education on fire protocols and the use of appropriate materials.
- Documentation: Maintain a laser safety checklist and ensure records are kept.
Ethics
- Defined as a system of moral principles guiding decision-making and behavior.
- Provides a framework for understanding good and bad conduct, assisting nurses in client relationships.
- Ethical conflicts may arise from patient or interdisciplinary interactions in the perioperative setting.
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Five Focal Virtues:
- Compassion: Focus on the patient's best interests.
- Discernment: Applying insight and judgment beneficially.
- Trustworthiness: Building trusting relationships with patients/families.
- Integrity: Practice with honesty and respect for dignity.
- Conscientiousness: Prioritizing the patient's best actions objectively.
CNO Ethical Values (2019)
- Essential values in perioperative nursing:
- Client well-being and choice.
- Privacy and confidentiality.
- Respect for life and maintaining commitments.
- Truthfulness and fairness.
Perioperative Nurse Practice Standards
- Knowledge Integration: Combining nursing, sciences, and humanities.
- Nursing Process: Effective clinical decision-making.
- Professional Accountability: Responsible conduct in practice.
- Collaborative Care: Ensuring safe patient care through teamwork with multidisciplinary members.
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Description
Test your knowledge on the skeletal system with this quiz covering ligaments, bone tissue, fracture fixation, bone grafts, and the periosteum. Understand the critical functions and roles of different components in the skeletal framework. Challenge yourself and see how much you know!
