ATI Chapter 67 Musculoskeletal Diagnostic Procedures

A nurse is caring for a client who sustained a traumatic injury to the leg in a farming accident resulting in amputation. Following an above-the-knee amputation, which of the following is the highest priority in the client's immediate postoperative care?

Risk for hemorrhage *According to Maslow's hierarchy, physiological needs must be met first. Amputation following a traumatic injury to the leg will likely involve severing and repairing major blood vessels. The client is at a high risk for injury or hemorrhage.

A client is discharged after having an open reduction and internal fixation of a fractured tibia with application of a plaster cast. The nurse teaches the client to evaluate for early signs of decreased circulation related to postsurgical edema. The nurse determines that the teaching was understood when the client identifies a manifestation of decreased circulation as...

Coldness of the toes. *Decreased venous return from the constriction caused by a cast may lead to impaired circulation of the toes. Manifestations of impaired circulation include toes that are cold, numb, tingling or swollen.

Two days after fracturing his tibia playing lacrosse, a college student is brought to the hospital accompanied by his roommate who reports that the client is not acting like himself and seems confused. The nurse notes that the client has a long leg cast on the right leg and that the client is disoriented to time and place. Vital signs reveal that the client is tachycardic and tachypneic. The nurse should assess the client for other signs of...

Fat embolism *Loss of approximately one-fifth or more of the normal blood volume produces hypovolemic shock. The loss can be caused by multiple complications, including external bleeding (from cuts or injury), bleeding from the gastrointestinal tract, internal bleeding, or diminished blood volume resulting from excessive loss of other body fluids. Although confusion and tachycardia are seen with hypovolemic shock, the clients history does not indicate this complication.

A client is on bed rest following a pelvic fracture when he suddenly becomes dyspneic and reports feeling short of breath. The nurse assesses the client and finds that tachycardia, hypotension, and tachypnea are occurring. The client's oxygen saturation level is dropping rapidly. The nurse should identify that the client is exhibiting signs consistent with...

Pulmonary embolus *A client who has had a fracture and is maintained on bed rest is at high risk for pulmonary emboli due to venous stasis and hypercoagulation. The typical presentation of a client with a blood clot in the arterial structure of the lung includes difficulty breathing, low blood pressure, and confusion. The clot occludes pulmonary arterial blood flow to the lung, resulting in hypoxia.

A client sustains an open fracture of the left femur. An intramedullary pin is inserted, and the client is placed in skeletal traction. While performing the initial assessment, the nurse finds the client has slipped down toward the foot of the bed and the traction weight is resting on the floor. The appropriate action is to...

Help the client use the trapeze to pull himself up in bed. *The traction is no longer effective when it is resting on the floor. Provided that nothing is out of alignment, the nurse should help the client resume his normal position in bed to reestablish traction.

A client has been admitted to the orthopedic floor to have a right total arthroplasty performed. What statement to the nurse that the client understands the preoperative teaching?

I will wear elastic stockings on both legs until I am discharged. *The purpose of elastic stocking is to prevent thrombophlebitis, which is a common complication following orthopedic surgery. Thromboemboli can occur up to 6 months after surgery, so it is possible that the client will wear them even after discharge.

A client involved in a motor vehicle crash sustained maxillofacial trauma from striking the windshield. The client receives intermaxillary fixation with interdental wiring. Postoperatively, the client vomits clear liquids. Which of the following actions is appropriate for the nurse to take?

Intermaxillary fixation is wiring of the teeth using the solid jaw to support the fractured jaw by holding the two together. The wires are usually left in place for around 6 weeks until the fracture is healed. Clear liquids that have been vomited can easily be removed from the oral cavity by suctioning in the buccal space (between the gums and teeth).

During a report, a nurse is told to assess a client who was recently casted for a radial fracture for compartment syndrome. For which of the following findings should the nurse assess?

Numbness and tingling *Compartment syndrome involves the compression of nerves and blood vessels within an enclosed space, leading to impaired blood flow and nerve damage. Thick layers of tissue called fascia separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment, that includes the muscle tissue, nerves, and blood vessels. Because fascia do not expand, any swelling in a compartment will lead to increasing pressure in that compartment, which will compress the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked, which can lead to permanent injury to the muscle and nerves. The hallmark symptom of compartment syndrome is severe pain that does not respond to elevation of pain medication. In more advanced cases, there may be numbness, tingling, weakness, and paleness of the skin.

A client is 3 days postoperative following a right total hip arthroplasty. The client cries out in pain when transferred to a chair. Which of the following nursing observations should lead to the suspicion of a dislocated hip prosthesis?

One of the classic indication of prosthetic dislocation is shortening of the affected leg, along with an inability to move it, abnormal rotation, and increased discomfort.

A nurse if admitting a client with a history of gout. Which of the following manifestations should the nurse expect to find on the client's admission physical assessment?

Tophi *Acute gouty arthritis is a metabolic disease marked by uric acid deposits in the joints. The disorder causes painful gouty arthritis, especially in the joints of the feet and legs. Tophi are deposits of urate crystal deposits that occur on the hands, knees, feet, forearms, and the Achilles tendons in a client with chronic gout.

A client with a radial fracture reports itching under the casted area. The appropriate nursing action to relieve itching is to...

Use a hair dryer on a cool setting to blow air into the cast. *The cool air will cause vasoconstriction and decrease neural transmission of sensation to the affected area.

A nurse is caring for a client who had a below the knee amputation for gangrene of the foot. The client knows that the foot has been amputated, but reports to the nurse severe pain in the toes of the injured foot. The nurse should recognize this as

an actual sensation. *The nurse should recognize that the client is reporting phantom limb pain. Phantom limb pain is related to severed nerve pathways and is a frequent complication in clients who experience limb pain prior to the amputation. Phantom limb pain occurs less frequently following traumatic amputation. The nurse should recognize the pain is real and manage it accordingly. It may be described as deep and burning, cramping, shooting, or aching. Symptoms may be managed with various medications, such as opioids, antispasmodics, antiepileptics, or beta blockers.

A client with an ankle sprain is being discharged from the emergency department. To promote tissue healing and relieve discomfort, the nurse instructs the client to...

apply cold compresses to the affected area. *Cold minimizes swelling and erythema to the affected area. However, cold compresses should not be applied continuously for more than 30 minutes.

A nurse in a rehabilitation facility is caring for a client with multiple fractures of both the lower extremities following a motor vehicle crash. The nurse realizes that the factor which is most critical for the client's successful rehabilitation is the...

client must be an active participant in the program. *Rehabilitation is a learning process in which the interdisciplinary rehabilitation team works closely with the client. Like any other learning process, the client must be motivated for learning to occur. The client and caregivers are actively involved in collaboratively setting goals, planning, and taking part in the treatment. This is the most important factor for successful rehabilitation.

Following should surgery, a client is instructed to keep the arm adducted at all times,. The nurse explains to the client that this means he must keep the arm...

close to the body. *Adducted means to position the arm toward the midline, or adjacent part of the body. By keeping the arm close to the body, the shoulder joint is properly kept adducted.

A night shift nurse if assigned to care for a client who is 12 hour postoperative following a total knee arthroplasty. The nurse finds the client's leg in a continuous passive motion machine, a drain attached to an evacuator unit is in place, and the client has a PCA device. The client reports to the nurse, "I am in so much pain." The nurse's first action at this time is to...

complete the assessment of the client including the client's pain. *A knee joint arthroplasty is surgery to replace a painful, damaged, or diseased knee joint with a prosthetic joint. The nurse should complete the client assessment before selecting a course of action regarding the pain. The nurse should determine the characteristics of the client's pain and the frequency with which the client is using the PCA device before deciding what the next best action is. When caring for client's, assessment always comes first, followed by analysis, planning, intervening, and finally evaluating.

A diabetic client with a non-healing wound of the heel is diagnosed with osteomyelitis. The nurse anticipates that the client's treatment regimen will include...

insertion of a peripherally inserted catheter line for long term IV antibiotics. *Osteomyelitis is an acute or chronic bone infection. when the bone is infected, pus is produced within the bone, which may result in an abscess. The affected bone may have been predisposed to infection because of recent trauma and diabetes mellitus is also a risk factor for the development of osteomyelitis. Long-term IV antibiotic therapy is usually needed to eradicate osteomyelitis, which can be very resistant to treatment in diabetic clients, and the client may eventually require amputation.

An assistive personnel at an extended care facility asks a nurse the difference between rheumatoid arthritis and osteoarthritis. The nurse responds Osteoarthritis is...

localized. * Osteoarthritis is a deterioration of cartilage and overgrowth of bone. Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage. Osteoarthritis is a localized process associated with aging and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing a bone to rub against another bone. Joints appear larger, are stiff and painful, and usually feel worse the more they are used throughout the day.

On a health history form, a client being admitted to an outpatient surgery center for a knee arthroscopy indicates taking celecoxib (Celebrex) daily. Based on the medication, the nurse should suspect that the client has a history of...

rheumatoid arthritis *Celecoxib is a nonsteroidal anti-inflammatory, cyclooxygenase-2 (COX-2) inhibitor, used to relieve some manifestations caused by rheumatoid arthritis in adults.

A nurse notes on a client's MAR that the client is to receive alendronate sodium (Fosamax). The nurse should know that for proper absorption of the medication the client must...

sit up for 30 min. after administration. *Alendronate sodium is a bisphosphonate, which is a classification of medications that prevent the development of osteoporosis. It must be given with a full glass of water first thing in the morning on an empty stomach atleast 30 min prior to consuming any other food, beverage, or medication. After taking the medication the client must remain seated upright for a minimum of 30 min. to prevent esophageal irritation.