Chap 40: Musculoskeletal Care Modalities

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? 1. Keep the knees together at all times 2. Bend forward only when seated in a chair 3. Avoid placing a pillow between the legs when sleeping 4.Never cross the affected leg when seated

4.Never cross the affected leg when seated

A client has undergone an external fixation. Which actions would be the priority for this client? 1. Maintaining pin care. 2. Planning the client's diet. 3. Monitoring the client's blood pressure. 4. Monitoring the client's urine output.

1. Maintaining pin care.

The nurse assesses a patient after total right hip arthroplasty and observes a shortening of the extremity, and the patient complains of severe pain in the right side of the groin. What is the priority action of the nurse? 1. Notify the physician. 2. Externally rotate the extremity. 3. Apply Buck's traction. 4.Bend the knee and rotate the knee internally.

1. Notify the physician.

paresthesia

an abnormal sensation of tingling or numbness or burning

traction

application of a pulling force to a part of the body

sling

bandage used to support an arm

avascular necrosis

death of tissue due to insufficient blood supply

splint

device designed specifically to support and immobilize a body part in a desired position

external fixator

external metal frame attached to bone fragments to stabilize them

brace

externally applied device to support the body or a body part, control movement, and prevent injury

osteomyelitis

infection of the bone

osteolysis

lysis of bone from inflammatory reaction against polyethylene particulate debris

heterotopic ossification

misplaced formation of bone

trapeze

overhead assistive device to promote patient mobility in bed

cast

rigid external immobilizing device molded to contours of body part

osteotomy

surgical cutting of bone

Open reduction

Correction and alignment of the fracture after surgical dissection and exposure of the fracture

Meniscectomy

Excision of damaged joint fibrocartilage

Fasciotomy

Incision and diversion of the muscle fascia to relieve muscle constriction, as in compartment syndrome, or to reduce fascia contracture

Tendon transfer

Insertion of tendon to improve function

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction

6 P's

Pain, poikilothermia, pallor, paresthesia, pulselessness, paralysis

Bone graft

Placement of bone tissue (autologous or homologous grafts) to promote healing, to stabilize, or to replace diseased bone

Amputation

Removal of a body part

Arthroplasty

Repair of joint problems through the operating arthroscope (an instrument that allows the surgeon to operate within a joint without a large incision) or through open joint surgery

Total joint arthroplasty or replacement

Replacement of both articular surfaces within a joint with metal or synthetic materials

Joint arthroplasty or replacement

Replacement of joint surfaces with metal or synthetic materials

Hemiarthroplasty

Replacement of one of the articular surfaces (e.g., in a hip hemiarthroplasty, the femoral head and neck are replaced with a femoral prosthesis—the acetabulum is not replaced)

internal fixation

Stabilization of the reduced fracture by the use of metal screws, plates, wires, nails, and pins

fracture

a break in the continuity of the bone

cast syndrome

psychological (claustrophobic reaction) or physiologic (superior mesenteric artery syndrome) responses to confinement in body cast

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: 1. An open reduction 2. A total hip replacement 3. A fasciotomy 4. A total knee replacement

3. A fasciotomy

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? 1.Atelectasis 2. Osteomyelitis 3. Hypovolemic shock 4. Urinary retention

3. Hypovolemic shock

Which action by the nurse would be inappropriate for the client following casting? 1. Protect the cast by covering with a sheet. 2. Handle the cast with the palms of hands. 3. Petal and smooth the edges of the cast. 4. Circulate room air with a portable fan.

1. Protect the cast by covering with a sheet.

A continuous passive motion (CPM) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply. 1. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. 2. The physician orders the frequency of use of the machine. 3. The physician orders the amount of extension and flexion produced by the machine. 4. The amount of flexion for clients with hip replacements should never exceed 60 degrees in the CPM machine.

1. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. 2. The physician orders the frequency of use of the machine. 3. The physician orders the amount of extension and flexion produced by the machine.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? 1. "The traction can be removed once a day so I can shower." 2. "A belt will go around my pelvis and weights will be attached." 3. "Metal pins will go through my skin to the bone." 4. "I will wear a boot with weights attached."

3. "Metal pins will go through my skin to the bone."

adduction

movement toward the center or median line of the body

neurovascular status

neurologic (motor and sensory components) and circulatory functioning of a body part

Which is an inaccurate principle of traction? 1. The weights must hang freely. 2. The weights are not removed unless intermittent treatment is prescribed. 3. Skeletal traction is interrupted to turn and reposition the client. 4. The client must be in good alignment in the center of the bed.

3. Skeletal traction is interrupted to turn and reposition the client.

Which principle applies to the client in traction? 1. Weights should rest on the bed. 2. Knots in the ropes should touch the pulley. 3. Skeletal traction is never interrupted. 4. Weights are removed routinely.

3. Skeletal traction is never interrupted.

Which would be contraindicated as a component of self-care activities for the client with a cast? 1. Do not attempt to scratch the skin under a cast 2. Cushioning rough edges of the cast with tape 3. Elevate the casted extremity to heart level frequently 4. Cover the cast with plastic to insulate it

4. Cover the cast with plastic to insulate it

Which would be consistent as a component of self-care activities for the client with a cast? 1. Use a plastic hanger wrapped in gauze to scratch under the cast. 2. Cover the cast with plastic to insulate it 3. Frequently place the casted extremity in a dependent position 4. Cushion rough edges of the cast with tape

4. Cushion rough edges of the cast with tape

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? 1. Educating the client about the effects of menopause 2. Advising the client to avoid red meat 3. Urging her to keep the affected limb in an elevated position 4. Exploring factors related to the client's home environment

4. Exploring factors related to the client's home environment

Which statement is accurate regarding care of a plaster cast? 1. The cast will dry in about 12 hours. 2. A dry plaster cast is dull and gray. 3. The cast must be covered with a blanket to keep it moist during the first 24 hours. 4. The cast can be dented while it is damp.

4. The cast can be dented while it is damp.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? 1. Hemiarthroplasty 2. Osteotomy 3. Arthrodesis 4. Total arthroplasty

4. Total arthroplasty

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? 1. Ropes freely moving over pulleys 2. Body aligned opposite to line of traction pull 3. Pulleys without evidence of the obstruction 4. Weights hanging and touching the floor

4. Weights hanging and touching the floor

abduction

movement away from the center or median line of the body