lOMoAR cPSD| 16310474
Med Surgery 2025 Revision
materials fully reviewed
Chapters 13, 15, 35-42
, lOMoAR cPSD| 16310474
Med Surg 2 Review Chapters 13, 15, 35-42
Osteoporosis
- When osteoclastic activity is greater than osteoblastic activity bones become porous and brittle
(Osteoporosis)
- A condition in which bones become weak and brittle.
-Calcium helps to maintain bone while vitamin D is essential for calcium absorption
- alendronate (Fosamax)- It can treat or prevent osteoporosis.
-Bisphosphonates (alendronate) inhibit osteoclastic activity and promote calcium deposition into
bone; Bisphosphonates such as Fosamax increase bone mass and decrease bone loss by
inhibiting osteoclast function.
- Osteonecrosis of the jaw is a potential risk with bisphosphonates so encourage yearly dental
evaluations
- Instruct patients to take oral bisphosphonates on an empty stomach, with 8 ounces of water and
to sit upright for at least 30 - 60 minutes (risk for esophageal ulcers)
-Instruct on the importance of calcium (1,200 mg) and vitamin D (600 IU) intake along with
sources (low-fat milk, yogurt, cheese); adults over 50 require 800 - 1000 IU of vitamin D
- Thin, Asian or Caucasian women have the greatest risk for osteoporosis
- Weight bearing activities, sex hormones, calcitonin and calcium intake support bone formation-
Estrogen stimulates osteoblastic (bone formation) activity and inhibits osteoclastic (bone
resorption) activity; thus menopause increases the risk for osteoporosis
-Excessive cortisol and thyroid hormone production increase bone resorption and could lead to
osteoporosis (hyperthyroidism)
-Calcitonin decreases serum calcium levels while parathyroid homorne increases serum calcium
levels
-Dual-energy x-ray absorptiometry (DEXA) scan is used to measure bone density and diagnose
osteoporosis (T score of -2.5)
- Osteoporosis is the most prevalent bone disease in the world.
-Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis.
-Bone fracture is a major complication of osteoporosis that results when loss of calcium and
phosphate increases the fragility of bones.
- Use opioids to manage phantom limb pain, which is actual pain that is felt after an amputation
- Manage nociceptive pain with local anesthetics, nonopioids or opioid
Total hip arthroplasty- (total hip replacement)
- Instruct the client following total hip arthroplasty to prevent dislocation by following hip
precautions for a minimum of 4 months (use raised toilet seats, avoid crossing the legs, no
bending at the waist, and sit with hips higher than the knees)
, lOMoAR cPSD| 16310474
- Prevent hip dislocation following total hip arthroplasty by abducting legs, prevent internal
rotation of leg, turn to the unaffected side while maintaining abduction, avoid flexing the hip
more than 90 degrees, keep leg in a neutral position, keep head of bed less than 60 degrees, and
avoid crossing the leg
-Orthopedic surgery increases the risk of deep vein thrombosis and infection so administer
enoxaparin (lovenox)
-Signs of hip dislocation include limb shortening, acute groin pain, external or internal rotation,
limb deformity, crepitus and reduced mobility
- Obtain an arterial blood gas if confusion, restlessness and irritability occur in the setting of a
fracture
external fixator
- is a stabilizing frame to hold the broken bones in proper position. In an external fixator, metal
pins or screws are placed into the bone through small incisions into the skin and muscle. The
pins and screws are attached to a bar outside the skin.
- Perform pin care by cleaning with a circular motion from the inner to the outer region and
cleaning each site separately
- External fixators increase the risk for osteomyelitis so perform pin site care using aseptic
technique (use chlorhexidine 2mg/mL solution unless contraindicated)
- Treat tissue injury with rest, ice, compression and elevation during the first 72 hours to limit
inflammation and promote healing
- Report signs of impaired neurovascular status (pallor, pain, paralysis, paresthesias, polar,
pulselessness) immediately
- Determine changes in arterial blood flow by assessing for pain, pallor, paresthesia, paralysis,
poikilothermia/polar, pulselessness and capillary refill
- Provide non-pharmacological pain management strategies such as physical modalities, mind-
body methods, biologic and energy based therapies (Offer to massage the lumbar back)
skin traction
, lOMoAR cPSD| 16310474
-It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture.
Once the material has been applied, weights are fastened to it. The affected body part is then
pulled into the right position using a pulley system attached to the hospital bed.
- Prevent skin breakdown from skin traction by repositioning (while maintaining a supine
position), using pressure relieving mattresses, inspecting the skin three times a day and
assessing for tenderness
- Traction helps to maintain bone alignment and to decrease pain from muscle spasms-Care for
the client with traction by ensuring traction is continuous and uninterrupted, weights hang
freely, knots are away from the pulley and the client 's body is in proper alignment
above the knee amputation position
-Prevent flexion contractures following amputations; prone position to prevent hip contractures
following an above the knee
Below the knee amputation position
-supine position without pillows under the knees following a below the knee amputation (except
first 24 hours)
-Apply uniform compression to the amputation to reduce limb edema (elastic limb shrinker) -
Prevent flexion contractures to the knee by avoiding pillows behind the knee or not using the
knee gatch on the bed
- Extend the limb following an amputation to prevent flexion contractures, keep legs close
together and avoid hip or knee flexion; instruct on not sitting for prolonged periods of time (hip
flexion)
cast to the right lower extremity
-Prevent disuse from immobilization by instructing the client on isometric exercises
Bone scan
-Instruct on the importance of hydration in eliminating the isotope use during a bone scan
-It is important to encourage the patient to drink plenty of fluids to help distribute and eliminate
the isotopic after it is injected. There are important contraindications to the procedure, include
pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous
radioisotope and the scan is preformed 2 to 3 hours after the isotope is injected.
Med Surgery 2025 Revision
materials fully reviewed
Chapters 13, 15, 35-42
, lOMoAR cPSD| 16310474
Med Surg 2 Review Chapters 13, 15, 35-42
Osteoporosis
- When osteoclastic activity is greater than osteoblastic activity bones become porous and brittle
(Osteoporosis)
- A condition in which bones become weak and brittle.
-Calcium helps to maintain bone while vitamin D is essential for calcium absorption
- alendronate (Fosamax)- It can treat or prevent osteoporosis.
-Bisphosphonates (alendronate) inhibit osteoclastic activity and promote calcium deposition into
bone; Bisphosphonates such as Fosamax increase bone mass and decrease bone loss by
inhibiting osteoclast function.
- Osteonecrosis of the jaw is a potential risk with bisphosphonates so encourage yearly dental
evaluations
- Instruct patients to take oral bisphosphonates on an empty stomach, with 8 ounces of water and
to sit upright for at least 30 - 60 minutes (risk for esophageal ulcers)
-Instruct on the importance of calcium (1,200 mg) and vitamin D (600 IU) intake along with
sources (low-fat milk, yogurt, cheese); adults over 50 require 800 - 1000 IU of vitamin D
- Thin, Asian or Caucasian women have the greatest risk for osteoporosis
- Weight bearing activities, sex hormones, calcitonin and calcium intake support bone formation-
Estrogen stimulates osteoblastic (bone formation) activity and inhibits osteoclastic (bone
resorption) activity; thus menopause increases the risk for osteoporosis
-Excessive cortisol and thyroid hormone production increase bone resorption and could lead to
osteoporosis (hyperthyroidism)
-Calcitonin decreases serum calcium levels while parathyroid homorne increases serum calcium
levels
-Dual-energy x-ray absorptiometry (DEXA) scan is used to measure bone density and diagnose
osteoporosis (T score of -2.5)
- Osteoporosis is the most prevalent bone disease in the world.
-Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis.
-Bone fracture is a major complication of osteoporosis that results when loss of calcium and
phosphate increases the fragility of bones.
- Use opioids to manage phantom limb pain, which is actual pain that is felt after an amputation
- Manage nociceptive pain with local anesthetics, nonopioids or opioid
Total hip arthroplasty- (total hip replacement)
- Instruct the client following total hip arthroplasty to prevent dislocation by following hip
precautions for a minimum of 4 months (use raised toilet seats, avoid crossing the legs, no
bending at the waist, and sit with hips higher than the knees)
, lOMoAR cPSD| 16310474
- Prevent hip dislocation following total hip arthroplasty by abducting legs, prevent internal
rotation of leg, turn to the unaffected side while maintaining abduction, avoid flexing the hip
more than 90 degrees, keep leg in a neutral position, keep head of bed less than 60 degrees, and
avoid crossing the leg
-Orthopedic surgery increases the risk of deep vein thrombosis and infection so administer
enoxaparin (lovenox)
-Signs of hip dislocation include limb shortening, acute groin pain, external or internal rotation,
limb deformity, crepitus and reduced mobility
- Obtain an arterial blood gas if confusion, restlessness and irritability occur in the setting of a
fracture
external fixator
- is a stabilizing frame to hold the broken bones in proper position. In an external fixator, metal
pins or screws are placed into the bone through small incisions into the skin and muscle. The
pins and screws are attached to a bar outside the skin.
- Perform pin care by cleaning with a circular motion from the inner to the outer region and
cleaning each site separately
- External fixators increase the risk for osteomyelitis so perform pin site care using aseptic
technique (use chlorhexidine 2mg/mL solution unless contraindicated)
- Treat tissue injury with rest, ice, compression and elevation during the first 72 hours to limit
inflammation and promote healing
- Report signs of impaired neurovascular status (pallor, pain, paralysis, paresthesias, polar,
pulselessness) immediately
- Determine changes in arterial blood flow by assessing for pain, pallor, paresthesia, paralysis,
poikilothermia/polar, pulselessness and capillary refill
- Provide non-pharmacological pain management strategies such as physical modalities, mind-
body methods, biologic and energy based therapies (Offer to massage the lumbar back)
skin traction
, lOMoAR cPSD| 16310474
-It involves applying splints, bandages, or adhesive tapes to the skin directly below the fracture.
Once the material has been applied, weights are fastened to it. The affected body part is then
pulled into the right position using a pulley system attached to the hospital bed.
- Prevent skin breakdown from skin traction by repositioning (while maintaining a supine
position), using pressure relieving mattresses, inspecting the skin three times a day and
assessing for tenderness
- Traction helps to maintain bone alignment and to decrease pain from muscle spasms-Care for
the client with traction by ensuring traction is continuous and uninterrupted, weights hang
freely, knots are away from the pulley and the client 's body is in proper alignment
above the knee amputation position
-Prevent flexion contractures following amputations; prone position to prevent hip contractures
following an above the knee
Below the knee amputation position
-supine position without pillows under the knees following a below the knee amputation (except
first 24 hours)
-Apply uniform compression to the amputation to reduce limb edema (elastic limb shrinker) -
Prevent flexion contractures to the knee by avoiding pillows behind the knee or not using the
knee gatch on the bed
- Extend the limb following an amputation to prevent flexion contractures, keep legs close
together and avoid hip or knee flexion; instruct on not sitting for prolonged periods of time (hip
flexion)
cast to the right lower extremity
-Prevent disuse from immobilization by instructing the client on isometric exercises
Bone scan
-Instruct on the importance of hydration in eliminating the isotope use during a bone scan
-It is important to encourage the patient to drink plenty of fluids to help distribute and eliminate
the isotopic after it is injected. There are important contraindications to the procedure, include
pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous
radioisotope and the scan is preformed 2 to 3 hours after the isotope is injected.
