Ch. 51 Care of Patients with Musculoskeletal Trauma

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? a. Surgical repair of the rotator cuff b. Prescribed exercises of the affected arm c. Activity limitations for the affected arm d. Patient-controlled analgesia with morphine

c. Activity limitations for the affected arm

pathophysiologic changes and increased of compartment pressure

ischemia-edema cycle

healed incorrectly

malunion

never completely healed

non-union

the fracture projects through the skin and there is a possibility of infection or hemorrhage

open or compound fracture

ischemic or avascular necrosis (death of bone tissue)

osteonecrosis

a macular measles like rash

petechiae

any object or device that extends to the joints above and below the fracture to immobilize it

splint

within 24-72 hours hematoma forms at site of the fracture

stage 1

3 days to 2 weeks granulation of tissue invades hematoma formation of fibrocartilage

stage 2

vascular and cellular profillation callcus formation

stage 3

callus is reabsorbed and transformed into bone takes 3 - 8 weeks

stage 4

consolidation and remodeling of bone

stage 5

bubbles under the skin because of air trapping

subcutaneous emphysema

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? Select all that apply. a. Occupational therapist b. Physical therapist c. Psychologist d. Respiratory therapist e. Speech therapist

a, b, and c

inelastic tissue that surrounds groups of muscles, blood vessels, and nerves in the body

Fascia

serious, life-threatening condition in which increased pressure within one or more compartments reduces circulation to the area

Acute compartment syndrome

A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 meter) fall. The nurse plans to assess the client for which potential complications? Select all that apply. a. Acute compartment syndrome (ACS) b. Fat embolism syndrome (FES) c. Congestive heart failure d. Urinary tract infection (UTI) e. Osteomyelitis

a, b, and e

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan? a. "Use pain medication as prescribed to control pain." b. "Clean the pin site when any drainage is noticed." c. "Wear the same clothing that is normally worn." d. "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

a. "Use pain medication as prescribed to control pain."

A client with peripheral vascular disease will undergo a Syme amputation. What will the nurse teach this patient when providing education about this procedure? a. "You will be able to bear weight without needing a prosthesis." b. "This type of procedure results in more pain than others." c. "The surgeon will remove both the foot and ankle." d. "This is an above-the-knee type of amputation."

a. "You will be able to bear weight without needing a prosthesis."

A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? a. Check the dorsalis pedis pulses. b. Immobilize the left leg with a splint. c. Administer the prescribed analgesic. d. Place a dressing on the affected area.

a. Check the dorsalis pedis pulses.

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? a. Keep the client's heels off the bed at all times. b. Reposition the client every 3 to 4 hours. c. Administer preventive pain medication before deep-breathing exercises. d. Prohibit the use of antiembolic stockings.

a. Keep the client's heels off the bed at all times.

A client sustains a fracture of one arm and the provider applies a plaster cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? a. Monitor neuromuscular status for decreased circulation and sensation in the extremity. b. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. c. Check the fit of the cast by inserting a tongue blade between the cast and the skin. d. Keep the cast covered with a soft towel to help it to dry quickly.

a. Monitor neuromuscular status for decreased circulation and sensation in the extremity.

1. What is the nurse's priority when doing an admission for a client who returned directly from the operating suite after a carpal tunnel repair? a. Monitor vital signs, including pulse oximetry. b. Check the surgical dressing to ensure it is intact. c. Assess neurovascular assessment in the affected arm. d. Monitor intake and output.

a. Monitor vital signs, including pulse oximetry.

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider immediately if which change occurs? a. Observation of a large amount of serosanguineous or bloody drainage b. Mild to moderate pain controlled with prescribed analgesics c. Absence of erythema and tenderness at the surgical site d. Ability to flex and extend the right knee

a. Observation of a large amount of serosanguineous or bloody drainage

Which intervention does the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? a. Talking with an amputee close to the client's age who has a similar amputation b. Drawing a picture of how the client sees him- or herself c. Talking with a psychiatrist about the amputation d. Engaging in diversional activities to avoid focusing on the amputation

a. Talking with an amputee close to the client's age who has a similar amputation

primary nursing concern with casts

assessment and prevention of neurovascular dysfunction

A client has a synthetic cast placed for a right wrist fracture in the emergency room. What priority health teaching is important for the nurse to provide for this client before returning home? (Select all that apply.) a. "Keep your right arm below the level of your heart as often as possible." b. "Use an ice pack for the first 24 hours to decrease tissue swelling." c. "Move the fingers of the right hand frequently to promote blood flow." d. "Report coolness or discoloration of your right hand to your doctor." e. "Don't place any device under the case to scratch the skin if it itches."

b, c, d, and e

A client has a grade III open fracture of the right tibia. To prevent infection, which intervention does the nurse implement? a. Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab. b. Use strict aseptic technique when cleaning the site. c. Leave the site open to the air to keep it dry. d. Assist the client to shower daily and pat the wound site dry.

b. Use strict aseptic technique when cleaning the site.

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? a. "A callus is quickly deposited and transformed into bone." b. "A hematoma forms at the site of the fracture." c. "Cellular and vascular proliferation surround the fracture site." d. "Granulation tissue reabsorbs the hematoma and deposits new bone."

b. "A hematoma forms at the site of the fracture."

The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site. a. 2, 4, 3, 1 b. 3, 4, 1, 2 c. 1, 4, 3, 2 d. 4, 1, 2, 3

b. 3, 4, 1, 2

A client who has a plaster leg splint reports a painful pressure sensation under the elastic wrap that is holding the splint in place. What is the nurse's best initial action? a. Remove the splint to reduce skin pressure. b. Perform a neurovascular assessment. c. Report the client's concern to the primary health care provider. d. Inspect the skin under the elastic bandage.

b. Perform a neurovascular assessment.

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? a. "My spouse will be the only person to change my dressing." b. "I can't believe that this has happened to me. I can't stand to look at it." c. "I do not want any visitors while I'm in the hospital." d. "It will take me some time to get used to this."

d. "It will take me some time to get used to this."

realignment of the bone ends for proper healing by closed method or open surgery

bone reduction

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan? a. "Avoid contact sports." b. "Avoid rigorous exercise." c. "Wear helmets when riding a motorcycle." d. "Avoid driving in inclement weather."

c. "Wear helmets when riding a motorcycle."

A client is in skeletal traction. Which nursing intervention ensures proper care of this client? a. Ensure that weights are placed on the floor. b. Ensure that pins are not loose and tighten as needed. c. Inspect the skin at least every 8 hours. d. Remove the traction weights only for bathing.

c. Inspect the skin at least every 8 hours.

A client undergoes a surgical amputation of a lower extremity after a motor vehicle crash. The client's vital signs are stable. What is a priority nursing action in the early postoperative period to help prevent complications in this client? a. Fitting the client with a prosthetic device b. Inspecting the limb stump daily for signs of skin breakdown c. Positioning and range-of-motion of the affected extremity d. Teaching the client and family how to apply shrinker stockings

c. Positioning and range-of-motion of the affected extremity

rigid device that immobilizes the affected body part while allowing other body parts mobility

cast

a completely internal break that does not involve a break in the skin

closed or simple fracture

the break is across the width of the bone, the bone is divided into two distinct sections

complete fracture

dysfunction of CNS and PNS that leads to severe chronic pain

complex regional pain syndrome (CRPS)

loading force applied to the long axis of cancellous bone

compression fracture

A client with a fracture asks the nurse about the difference between an open fracture and a simple fracture. Which statement by the nurse is correct? a. "Simple fracture involves a break in the bone, with skin contusions." b. "An open fracture does not extend through the skin." c. "Simple fracture has an increased risk for infection and emboli." d. "An open fracture involves a break in the bone, with damage to the skin."

d. "An open fracture involves a break in the bone, with damage to the skin."

1. A client who had an elective below-the-knee amputation (BKA) reports pain in the foot that was amputated last week. What is the nurse's most appropriate response to the client's pain? a. "The pain will go away after the swelling decreases." b. "That's phantom limb pain and every amputee has that." c. "Your foot has been amputated, so it's in your head." d. "On a scale of 0 to 10, how would you rate your pain?"

d. "On a scale of 0 to 10, how would you rate your pain?"

Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? a. Removing the wound drain for a client who had an open reduction of a hip fracture 3 days ago. b. Assessing for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. c. Teaching a client with a right ankle fracture how to use crutches when transferring and ambulating. d. Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

d. Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

The nurse performs a neurovascular assessment on a client with closed multiple fractures of the right humerus who is experiencing increased pain even with maximum ordered doses of morphine. The nurse notes distal capillary refill of 3 seconds and coolness of the hand and fingers. The client reports numbness of the hand and is unable to wiggle the thumb. Which nursing action is indicated? a. Elevate the extremity. b. Apply an ice pack to the extremity. c. Reposition the extremity and recheck in 15-20 minutes. d. Notify the provider of these findings.

d. Notify the provider of these findings.

An older adult client has multiple tibia and fibula fractures of the left extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client? a. Cyclobenzaprine (Flexeril) b. Ibuprofen (Advil) c. Meperidine (Demerol) d. Patient-controlled analgesia (PCA) with morphine

d. Patient-controlled analgesia (PCA) with morphine

Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? a. Skin to evaluate lacerations and abrasions. b. Lungs for bilateral normal breath sounds c. Pain score and level of alertness d. Urine dipstick for the presence of red blood cells.

d. Urine dipstick for the presence of red blood cells.

fracture that has not healed within 6 months of injury

delayed union

bruised from bleeding into the underlying soft tissue

ecchymotic

fat gobbles are released from the yellow bone marrow into the bloodstream

fat embolism syndrome

excessive strain and stress on bone causing it to break

fatigue or stress fracture

most common material used for cast

fiberglass

a break or disruption in continuity of a bone

fracture

minimal trauma to a bone that has been weakened by disease

fragility or spontaneous fracture

the break does not divide the bone into two portions

incomplete fracture