- Email: [email protected]
Examination: Minimally invasive total hip arthroplasty
JUNE 2004, VOL 79, NO 6
Examination
txa mi nation Minimally invasive t o t a l hip arthroplasty 1. Historically, improvements in total
hip arthroplasty surgery include 1.better implant materials. 2. development and improvement of porous acetabular and femoral stem prostheses. 3, improved mechanisms for holding implants in place. 4. smaller incisions and minimally invasive techniques. a. 1 and 2 b. 1, 3, and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 2. Minimally invasive total hip arthroplasty (MITHA) procedures are performed through an incision that is less than 10-cm long. a. true b. false
3. Benefits of minimally invasive techniques include 1.decreased blood loss. 2. faster rehabilitation. 3. improved visualization. 4. decreased cost. 5. smaller incisions that preserve muscle and ligament strength. a. 1 and 4 b. 1, 2, and 5 c. 2, 3, 4,and 5 d. 1, 2, 3, 4,and 5
4. Total hip replacements relieve the pain caused by 1. congenital leg length discrepancy. 2. osteoarthritis. 3. osteonecrosis. 4. rheumatoid arthritis. a. 1 and 3 b. 2 and 4
c. 2, 3, and 4 d. 1, 2, 3, and 4 5. Prophylactic antibiotics should be
administered a. 24 hours before surgery. b. within 30 minutes before the incision i s made. c. within 30 minutes after the incision i s made. d. 24 hours after surgery. 6. Which of the following nursing
diagnoses are appropriate for patients undergoing MITHA? 1. risk for impaired gas exchange 2. risk of acute and chronic pain 3. risk of altered nutrition 4. risk of ineffective breathing patterns. 5. risk of infection a. 3 and 4 b. 1, 2, and 3 c. 1, 2, and 5 d. 2, 3, 4,and 5 7. The nurse assesses for a positive
Homan’s sign which might indicate a. arthritis. b. peroneal nerve injury. c. stress fracture. d. thrombophlebitis. 8. When performing single-incision
MITHA, in what position should the patient be placed? a. lateral b. lithotomy c. prone d. supine 9. A gel roll is placed under the depen-
dent axilla to minimize stretching or
AORN is o d t e d as o pmvider of continuing nursing educotibn by the American Nurses Credentialing Centefs Commission on Accreditation. AORN recognizes these activities as continuing educationfor wirered nurses. This recognition does not imply thot AORN or the American Nurses Credentialing Center appnwes or endorses productr mentioned in the activity. AORN is pmvidera P P d bY the California Board of Regiitered Nursing, Provider Number CEP 13019.
AORN JOURNAL
1 259
JUNE 2004, VOL 79, NO 6
Examination
compression of the patient's
a. brachial plexus. b. pedal arteries. G peroneal nerve. d. sciatic nerve. 10.After surgery, nurses h e l p patients ambulate
a.with full weight bearing within two hours. b.with full weight bearing within four hours. c. with partial weight bearing within two hours. d. with partial weight bearing within four hours.
Information on AORN's Correct Site Surgery Tool Kit part of AORN's commitment t o patient safety, AORN's "Correct Site Surgery Tool Kit" was mailed free of charge t o a l l members, facility chief executive officers (CEOs), and risk managers at the end of April 2004. The tool kit has received endorsement from the American College of Surgeons, the American Society of Anesthesiologists, the American Society for Healthcare Risk Management, the American Hospital Association, and the American Association of Ambulatory Surgery Centers. I n addition, staff members of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provided valuable support t o AORN i n developing the tool kit. The tool kit contains critical and concise information t o help facilities implement JCAHO's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The protocol includes a preoperative verification process, a process t o mark the intended site of the procedure, and a time-out immediately before the procedure commences t o verify the correct patient; procedure; and site, including laterality. Developed by AORN and produced under an educational grant from Sandel Medical Industries, Inc, the tool kit contains a copy of the JCAHO Universal Protocol and Guidelines for Implementation; a CD-ROM featuring best practice techniques used i n the implementation of the Universal Protocol; a pocket reference card with the three steps necessary t o promote correct site surgery; letters to perioperative nurses, physicians, CEOs,
As
1260
AORN JOURNAL
and risk managers encouraging them t o promote standardization of the Universal Protocol i n all facilities; a sample policy template; answers t o frequently asked questions, references, and web sites that contain additional information; a patient education brochure titled "Help prevent errors i n your care: For surgical patients"; and information about earning one contact hour. Work began on the tool k i t after a recommendation was made by the AORN Presidential Commission on Patient Safety i n September 2003. Although AORN and more than 40 health care organizations have endorsed the JCAHO Protocol, the Presidential Commission realized that endorsement of the Universal Protocol was not enough, and perioperative nurses need additional resources t o implement this protocol effectively. The Joint Commission w i l l begin surveying institutions based on the Universal Protocol guidelines i n July 2004. AORN encourages adoption of the JCAHO Universal Protocol i n every facility. Additional copies of the tool k i t are available for purchase for $5.95 for members and $11.95 for nonmembers, plus $4 postage and handling. To purchase copies, contact AORN customer service at (800) 755-2676 x 1 or send an e-mail t o
[email protected]. Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Penon Surgery is trademark of the Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Ill.
JUNE 2004,VOL 79, NO 6
Answer Sheet
Answer Sheet Minimally invasive t ot a 1 hip art hro p lasty
P
lease fill out the application and answer form on this page and the evaluationform on the back of this page. Tear the page out of the Journal or make photocopies and mail to:
ID Number
€vent #04064 0000000000~ Session 0@@@@@0@@@2 #a164
0000000000 0000000000 0000000000 0000000000
AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 or fax with credit card information to (303) 750-3212. Additionall& please verifv by signature that you
Session Number
Fee: Members $18.50 Nonmembers 537
0000000000 0000000000 0000000000 0000000000
have r e v i e w e d the objectives and rwd the article, or you will not m * v ecredit.
Signature
Contact hours: 3.7
Mark only one answer per question.
1.Record your AORN member identifi-
cation number in the appropriate section below. (See your member card.) 2. Completely darken the spaces that indicate your answers to examination questions one through 10. Use blue or black ink only. 3. Our accreditingbody requires that we venfy the amount of time you required to complete this 3.7 contact hour (185minute) program. 4. Enclose fee if information is mailed. AORN (ID) # Name Address City Phone number RN license # Fee enclosed or bill the credit card indicated Card # Signature
100000 2 0 0 0 0 0 3 0 0 0 0 0
6 0 0 0 0 0
400000
700000 800000 900000
500000
1000000
prosmm
offered June 2004
The deadline jbr this prvgmm is June 30, 2007 A score of 70% correct on the examination is required for credit.
State
Zip
State
0MC 0Visa
American Express 0Discover Expiration date (for credit card authorizatfon)
AORN JOURNAL
12 6 1
Learner Evaluation
JUNE 2004, VOL 79, NO 6
Learner Evaluatio n Minimally invasive t o t a l hip arthroplasty Objectives To what extent were the following objectives of this Home Study Program achieved? 1. Discuss the pertinent anatomy that is affected by pathological changes that ultimately require hip replacement. 2. Explain preoperative preparation for minimally invasive total hip arthroplasty (MITHA). 3. Identify the critical elements of positioning the patient for a MITHA. 4. Describe the differences between single- and double-incision approaches to MITHA.
Content 5. Did this article increase your
knowledge of the subject matter? 6. Was the content clear and organized? 7. Did this article facilitate learning? 8. Were your individual objectives
met?
Session Numberd, 0000000000 0000000000 0000000000 0000000000
-
(Low) (High) (Low) (High)
100000 11 0 0 0 0 0 200000 12 0 0 0 0 0 300000 13 0 0 0 0 0 400000 14' 0 0 0 0 0 Purpose/Goal: 500000 15100000 To educate 600000 16~ 0 0 0 0 0 pefiopemtiw 700000 17' 0 0 0 0 0 800000 1a; a @ @ @ @nurses obout Perfomring 900000 19' 0 0 0 0 0 total hip 1000000 210' 0 0 0 0 0
15.What factor most affects whether you take an AORN Journal Home to the overall purpose/goal? Study? a. need for contact hours Test Questions/Answers b. price 10. Were they reflective of the content? c. subject matter relevant to current 11.Were they easy to understand? position 12. Did they address important points? d. number of contact hours offered What other topics would you like to see Learner Input 13. Will you be able to use the infor- addressed in a future Home Study mation from this Home Study in Program? Would you be interested or do you know someone who would be interyour work setting? ested in writing an article on this topic? a. yes b. no 14.I learned of this Home Study via a. the Journal I receive as an AORN Topic(s): member. Author names and addresses: b. a Journal I obtained elsewhere. c. the AORN web site. d. SSM Online.
9. How well did the objectives relate
126 2
AORN JOURNAL
This evaluation is used to determine the extent to which this Home Study prosrOm met your learning needs. Rate these items on a scale of 1 to 5.
otthmplasty procedures via a minimally invasiw appmch.
Examination
txa mi nation Minimally invasive t o t a l hip arthroplasty 1. Historically, improvements in total
hip arthroplasty surgery include 1.better implant materials. 2. development and improvement of porous acetabular and femoral stem prostheses. 3, improved mechanisms for holding implants in place. 4. smaller incisions and minimally invasive techniques. a. 1 and 2 b. 1, 3, and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 2. Minimally invasive total hip arthroplasty (MITHA) procedures are performed through an incision that is less than 10-cm long. a. true b. false
3. Benefits of minimally invasive techniques include 1.decreased blood loss. 2. faster rehabilitation. 3. improved visualization. 4. decreased cost. 5. smaller incisions that preserve muscle and ligament strength. a. 1 and 4 b. 1, 2, and 5 c. 2, 3, 4,and 5 d. 1, 2, 3, 4,and 5
4. Total hip replacements relieve the pain caused by 1. congenital leg length discrepancy. 2. osteoarthritis. 3. osteonecrosis. 4. rheumatoid arthritis. a. 1 and 3 b. 2 and 4
c. 2, 3, and 4 d. 1, 2, 3, and 4 5. Prophylactic antibiotics should be
administered a. 24 hours before surgery. b. within 30 minutes before the incision i s made. c. within 30 minutes after the incision i s made. d. 24 hours after surgery. 6. Which of the following nursing
diagnoses are appropriate for patients undergoing MITHA? 1. risk for impaired gas exchange 2. risk of acute and chronic pain 3. risk of altered nutrition 4. risk of ineffective breathing patterns. 5. risk of infection a. 3 and 4 b. 1, 2, and 3 c. 1, 2, and 5 d. 2, 3, 4,and 5 7. The nurse assesses for a positive
Homan’s sign which might indicate a. arthritis. b. peroneal nerve injury. c. stress fracture. d. thrombophlebitis. 8. When performing single-incision
MITHA, in what position should the patient be placed? a. lateral b. lithotomy c. prone d. supine 9. A gel roll is placed under the depen-
dent axilla to minimize stretching or
AORN is o d t e d as o pmvider of continuing nursing educotibn by the American Nurses Credentialing Centefs Commission on Accreditation. AORN recognizes these activities as continuing educationfor wirered nurses. This recognition does not imply thot AORN or the American Nurses Credentialing Center appnwes or endorses productr mentioned in the activity. AORN is pmvidera P P d bY the California Board of Regiitered Nursing, Provider Number CEP 13019.
AORN JOURNAL
1 259
JUNE 2004, VOL 79, NO 6
Examination
compression of the patient's
a. brachial plexus. b. pedal arteries. G peroneal nerve. d. sciatic nerve. 10.After surgery, nurses h e l p patients ambulate
a.with full weight bearing within two hours. b.with full weight bearing within four hours. c. with partial weight bearing within two hours. d. with partial weight bearing within four hours.
Information on AORN's Correct Site Surgery Tool Kit part of AORN's commitment t o patient safety, AORN's "Correct Site Surgery Tool Kit" was mailed free of charge t o a l l members, facility chief executive officers (CEOs), and risk managers at the end of April 2004. The tool kit has received endorsement from the American College of Surgeons, the American Society of Anesthesiologists, the American Society for Healthcare Risk Management, the American Hospital Association, and the American Association of Ambulatory Surgery Centers. I n addition, staff members of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provided valuable support t o AORN i n developing the tool kit. The tool kit contains critical and concise information t o help facilities implement JCAHO's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The protocol includes a preoperative verification process, a process t o mark the intended site of the procedure, and a time-out immediately before the procedure commences t o verify the correct patient; procedure; and site, including laterality. Developed by AORN and produced under an educational grant from Sandel Medical Industries, Inc, the tool kit contains a copy of the JCAHO Universal Protocol and Guidelines for Implementation; a CD-ROM featuring best practice techniques used i n the implementation of the Universal Protocol; a pocket reference card with the three steps necessary t o promote correct site surgery; letters to perioperative nurses, physicians, CEOs,
As
1260
AORN JOURNAL
and risk managers encouraging them t o promote standardization of the Universal Protocol i n all facilities; a sample policy template; answers t o frequently asked questions, references, and web sites that contain additional information; a patient education brochure titled "Help prevent errors i n your care: For surgical patients"; and information about earning one contact hour. Work began on the tool k i t after a recommendation was made by the AORN Presidential Commission on Patient Safety i n September 2003. Although AORN and more than 40 health care organizations have endorsed the JCAHO Protocol, the Presidential Commission realized that endorsement of the Universal Protocol was not enough, and perioperative nurses need additional resources t o implement this protocol effectively. The Joint Commission w i l l begin surveying institutions based on the Universal Protocol guidelines i n July 2004. AORN encourages adoption of the JCAHO Universal Protocol i n every facility. Additional copies of the tool k i t are available for purchase for $5.95 for members and $11.95 for nonmembers, plus $4 postage and handling. To purchase copies, contact AORN customer service at (800) 755-2676 x 1 or send an e-mail t o
[email protected]. Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Penon Surgery is trademark of the Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Ill.
JUNE 2004,VOL 79, NO 6
Answer Sheet
Answer Sheet Minimally invasive t ot a 1 hip art hro p lasty
P
lease fill out the application and answer form on this page and the evaluationform on the back of this page. Tear the page out of the Journal or make photocopies and mail to:
ID Number
€vent #04064 0000000000~ Session 0@@@@@0@@@2 #a164
0000000000 0000000000 0000000000 0000000000
AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 or fax with credit card information to (303) 750-3212. Additionall& please verifv by signature that you
Session Number
Fee: Members $18.50 Nonmembers 537
0000000000 0000000000 0000000000 0000000000
have r e v i e w e d the objectives and rwd the article, or you will not m * v ecredit.
Signature
Contact hours: 3.7
Mark only one answer per question.
1.Record your AORN member identifi-
cation number in the appropriate section below. (See your member card.) 2. Completely darken the spaces that indicate your answers to examination questions one through 10. Use blue or black ink only. 3. Our accreditingbody requires that we venfy the amount of time you required to complete this 3.7 contact hour (185minute) program. 4. Enclose fee if information is mailed. AORN (ID) # Name Address City Phone number RN license # Fee enclosed or bill the credit card indicated Card # Signature
100000 2 0 0 0 0 0 3 0 0 0 0 0
6 0 0 0 0 0
400000
700000 800000 900000
500000
1000000
prosmm
offered June 2004
The deadline jbr this prvgmm is June 30, 2007 A score of 70% correct on the examination is required for credit.
State
Zip
State
0MC 0Visa
American Express 0Discover Expiration date (for credit card authorizatfon)
AORN JOURNAL
12 6 1
Learner Evaluation
JUNE 2004, VOL 79, NO 6
Learner Evaluatio n Minimally invasive t o t a l hip arthroplasty Objectives To what extent were the following objectives of this Home Study Program achieved? 1. Discuss the pertinent anatomy that is affected by pathological changes that ultimately require hip replacement. 2. Explain preoperative preparation for minimally invasive total hip arthroplasty (MITHA). 3. Identify the critical elements of positioning the patient for a MITHA. 4. Describe the differences between single- and double-incision approaches to MITHA.
Content 5. Did this article increase your
knowledge of the subject matter? 6. Was the content clear and organized? 7. Did this article facilitate learning? 8. Were your individual objectives
met?
Session Numberd, 0000000000 0000000000 0000000000 0000000000
-
(Low) (High) (Low) (High)
100000 11 0 0 0 0 0 200000 12 0 0 0 0 0 300000 13 0 0 0 0 0 400000 14' 0 0 0 0 0 Purpose/Goal: 500000 15100000 To educate 600000 16~ 0 0 0 0 0 pefiopemtiw 700000 17' 0 0 0 0 0 800000 1a; a @ @ @ @nurses obout Perfomring 900000 19' 0 0 0 0 0 total hip 1000000 210' 0 0 0 0 0
15.What factor most affects whether you take an AORN Journal Home to the overall purpose/goal? Study? a. need for contact hours Test Questions/Answers b. price 10. Were they reflective of the content? c. subject matter relevant to current 11.Were they easy to understand? position 12. Did they address important points? d. number of contact hours offered What other topics would you like to see Learner Input 13. Will you be able to use the infor- addressed in a future Home Study mation from this Home Study in Program? Would you be interested or do you know someone who would be interyour work setting? ested in writing an article on this topic? a. yes b. no 14.I learned of this Home Study via a. the Journal I receive as an AORN Topic(s): member. Author names and addresses: b. a Journal I obtained elsewhere. c. the AORN web site. d. SSM Online.
9. How well did the objectives relate
126 2
AORN JOURNAL
This evaluation is used to determine the extent to which this Home Study prosrOm met your learning needs. Rate these items on a scale of 1 to 5.
otthmplasty procedures via a minimally invasiw appmch.