CH 62 - Soft Tissue Injuries

Which intervention will reduce the risk of infection in a patient who has sustained an open fracture of the femur? Applying an ice pack Administering analgesics Administering tetanus prophylaxis Immobilizing the affected extremity

Administering tetanus prophylaxis Tetanus prophylaxis is administered when the patient has an open wound and an increased risk of infection. Application of ice may help to relieve pain. Analgesics may help to relieve pain. Immobilizing the extremity helps to provide comfort.

Which condition does the nurse suspect in a patient with a traumatic ligament tear caused by a combination of excessive deceleration force and limb rotation? Subluxation injury Meniscus injury Rotator cuff tear Anterior cruciate ligament (ACL) tear

Anterior cruciate ligament (ACL) tear An ACL tear occurs where there is traumatic knee ligament tear caused by a combination of excessive deceleration force and knee rotation. Subluxation injury is a partially dislocated joint resulting from a severe sprain (ligament damage) or strain (muscle or tendon damage) commonly caused by trauma such as a fall. A meniscus injury occurs when there is torn or damaged knee cartilage commonly caused by deep squats and heavy lifting. A rotator cuff is a capsule containing cluster of muscles and tendons that support the arm at the shoulder joint; a rotator cuff tear is commonly caused by aging and/or repetitive stress to the shoulder and occurs when there has been injury to the muscle or in the tendon and ligament structures around the shoulder.

A patient reports pain of the knee. The nurse flexes the knee by 25 degrees and also pulls the tibia forward while keeping the femur stable. The nurse feels a soft forward motion of the tibia with an indistinct endpoint. The nurse suspects which diagnosis? Bursitis Rotator cuff injury Carpal tunnel syndrome Anterior cruciate ligament injury

Anterior cruciate ligament injury The knee with an anterior cruciate ligament tear may produce a positive Lachman's test. This test involves flexing the knee by 15 to 30 degrees and pulling the tibia forward, keeping the femur stable. It is considered positive with forward motion of the tibia with a soft feeling and indistinct endpoint. This test is not performed to assess bursitis. A rotator cuff injury may be examined by a drop arm test. Carpel tunnel syndrome may be examined by positive results for Tinel's sign and Phalen's sign.

The nurse questions which item that is listed on the plan of care for the initial management of a patient with an injured ankle ligament? Apply ice to the ankle. Limit movement of the ankle. Keep the affected ankle elevated. Apply warm, moist heat to the ankle.

Apply warm, moist heat to the ankle. The application of warm compresses should be applied after the acute phase of injury as the risk of internal bleeding subsides. Cold is most useful when applied immediately after an injury has occurred and is used for 24 to 28 hours. The ankle should be elevated to prevent swelling and encourage fluid drainage. The movement of the ankle should be restricted to relive pain and provide rest.

Which are the closed sacs that are lined with synovial membrane, contain a small amount of synovial fluid, and are located at sites of friction in the joints? Bursae Menisci Rotator cuff Carpal tunnel

Bursae Bursae are the closed sacs lined with synovial membrane containing a small amount of synovial fluid. These are located at sites of friction, such as between tendons and bones, and near the joints. The crescent-shaped pieces of fibrocartilage in the knee, located at the sites of friction, are menisci. The rotator cuff is the complex of four shoulder muscles, the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. The tunnel formed by ligaments and bones is the carpal tunnel.

A patient is hospitalized with severe injuries to the ligament surrounding the hip joint. The patient can develop which syndrome if the fascia surrounding the muscle has limited ability to stretch? Overuse syndrome Impingement syndrome Carpal tunnel syndrome Compartment syndrome

Compartment syndrome Compartment syndrome is a condition in which swelling causes increased pressure within a limited space (muscle compartment). Because the fascia surrounding the muscle has limited ability to stretch, continued swelling can cause pressure that compromises the function of blood vessels and nerves in the compartment. Compartment syndrome often involves the leg. Overuse syndrome results from repetitive movements and awkward postures. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder. Carpal tunnel syndrome may be caused by median nerve compression; the median nerve enters the hand through the carpal tunnel's narrow confines.

A patient sustains a severe hip injury with dislocation in the posterior direction. Joint aspiration reveals hemarthrosis. Which diagnosis does the nurse suspect? Bursitis Arthrofibrosis Avascular necrosis Intraarticular fracture

Intraarticular fracture Severe injury may result from posterior hip dislocation due to damage to the ligament structure around the joint. The presence of hemarthrosis indicates an intraarticular fracture and bleeding into the joint space. Bursitis is the inflammation of closed sac bursae. Arthrofibrosis is the "freezing" of the shoulder after prolonged immobilization after surgery. Avascular necrosis is associated with inadequate blood supply, resulting in bone cell death.

Assessment findings of a patient with an anterior cruciate ligament (ACL) injury indicate the presence of tight and painful effusion. The nurse anticipates that the patient's treatment plan will include which intervention to relieve the effusion? Ice application Elevation of the knee Nonsteroidal antiinflammatory drug (NSAID) administration Joint aspiration

Joint aspiration The anterior cruciate ligament injury may involve a tear from the bone attachments that form the knee. The patient may report a tight and painful effusion, and a joint aspiration may be needed. Application of ice interferes with transmission of pain impulses and may not help in joint effusion. Elevation of the knee relieves edema. NSAIDs such as aspirin may relieve the pain at the injury site but may not relieve effusion.

Which activity may precipitate bursitis? Kneeling repeatedly Lifting heavy weights Using a keyboard frequently Sitting with crossed legs for a short time

Kneeling repeatedly Bursitis is the inflammation of the bursae. Common precipitating activities include repetitive kneeling or running in worn-out shoes. Activities such as lifting heavy objects and the frequent use of a computer keyboard can cause cumulative trauma disorder. Bursitis is also precipitated by sitting with crossed legs for prolonged time periods, not for a short time.

The nurse is caring for a patient with a dislocated hip. The nurse recalls that this type of injury is associated most commonly with which event? Fall from a high place Osteoporosis of the hip Motor vehicle collisions Pathologic fracture of the hip

Motor vehicle collisions The hip is the most common dislocation of the lower extremity and generally is associated with motor vehicle collisions. Falls from a high place generally result in a fracture. Osteoporosis of the hip joint is more likely to result in a fracture and not dislocation. Pathologic fractures secondary to a history of cancer are not associated with hip dislocations.

A patient states, "I twisted my ankle while walking." Which assessment finding makes the nurse suspect that the injury is a third-degree sprain? Swelling around the ankle Pain on movement of the ankle Redness of the skin around the ankle Muscle gap on palpation of the skin around the ankle

Muscle gap on palpation of the skin around the ankle A third-degree sprain involves complete tearing of the ligament, and a gap in the muscle may be apparent or be palpated through the skin. The swelling may occur due to the inflammatory responses by the released mediators but is not specific to the degree of sprain. Redness may or may not be present. The patient may feel pain due to the injury irrespective of the degree of the sprain, but the pain becomes severe in a third-degree sprain.

A patient with tendonitis experiences a recurrence of symptoms. The nurse expects that which assistive device will be included in the patient's plan of care? Walker Orthosis Crutches Gait belts

Orthosis Tendonitis may be described as the inflammation of a tendon due to overuse or incorrect use. An orthosis is a protective brace used in the treatment of recurrence of symptoms. Walkers, crutches, and gait belts can aid in walking but do not prevent recurrence of symptoms.

The nurse reviews the medical record of a patient with bursitis and identifies that which history finding is associated with the condition? Fracture Meniscus injury Rheumatoid arthritis Carpal tunnel syndrome

Rheumatoid arthritis Bursitis is the inflammation of the closed sacs lined by the synovial membrane that contain synovial fluid. This inflammation may result from rheumatoid arthritis, which is a chronic disease causing inflammation in the joints. A fracture is a disruption in bone continuity and is unlikely to cause bursitis. Meniscus injuries are associated with ligament sprains and may not lead to bursitis. Carpal tunnel syndrome is median nerve compression and is not associated with bursitis.

The nurse provides education for a group of nursing students and provides which description of carpel tunnel syndrome (CTS)? The tear within the muscle or tendinoligamentous structures around the shoulder The entrapment of soft tissue structures under the coracoacromial arch of the shoulder The compression of the median nerve that enters the hand through the narrow confines of the carpal tunnel The injury to fibrocartilage of knee, characterized by popping, clicking, tearing sensation; effusion; and swelling

The compression of the median nerve that enters the hand through the narrow confines of the carpal tunnel CTS involves the compression of the median nerve, which enters the hand through the narrow confines of the carpal tunnel. A rotator cuff tear is a tear within the muscle or tendinoligamentous structures around shoulder. The entrapment of soft tissue structures under the coracoacromial arch of the shoulder is impingement syndrome. The injury to fibrocartilage of the knee, characterized by popping, clicking, tearing sensation; effusion; and swelling is a meniscus injury.

A patient who works at a desk and uses a computer reports persistent pain and stiffness in the neck. Which action by the patient may be the cause of the symptoms? The patient takes hourly stretch breaks. The patient elevates the wrist when typing. The patient keeps the top of the computer monitor even with the forehead. The patient keeps the hips and knees flexed to 90 degrees with feet flat while sitting.

The patient elevates the wrist when typing. The patient with a cervical injury who frequently works at a desk and uses the computer may suffer from a repetitive strain injury from repetitive movements and awkward positions of the wrist. Taking hourly stretch breaks helps to promote circulation. The computer monitor's top should be kept even with the forehead to keep the neck muscles from straining. The hips and knees should be kept flexed at 90 degrees with the feet flat.

A patient experiences a ligament injury to the ankle joint. To relieve edema, which instruction does the nurse include in the patient's discharge education? Apply ice to the affected area for 45 minutes at a time. Elevate the injured part at heart level. Immobilize the injured part for 24 hours. Wrap an elastic bandage from distal to proximal end.

Wrap an elastic bandage from distal to proximal end. An elastic bandage should be wrapped around the injured part to relieve edema and encourage venous return. Cold is most useful when applied immediately after an injury has occurred and used for 24 to 28 hours. The patient should apply ice no more than 20 to 30 minutes at a time. The patient should elevate the injured part above heart level. Unless the injury is severe, prolonged rest is usually not needed.