Skeletal System Quiz

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

• 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

• 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.
• 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.
• 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).
• 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.
• 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

• 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.
• 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.

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!