Chapter 62: caring for clients with traumatic musculoskeletal injuries Prep- U Med Surg
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?
"Apply ice packs for the first 24 to 48 hours, then apply heat packs."
A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?
"Elevating the leg might lead to a flexion contracture."
How long does it take for the bone to regain its former structural strength after a break?
1 year
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?
Assessing the left leg
A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?
Client can demonstrate safe use of assistive devices.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?
Comminuted
Radiographs of a client's upper arm shows three fragments of the humeral bone. This diagnostic result suggests what type of fracture?
Comminuted
In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?
Compartment syndrome
In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor?
Compartment syndrome
Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect?
Compartment syndrome.
A nurse admits a client who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse should plan to care for what type of fracture?
Compound
Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?
Compound
A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?
Coughing and deep breathing with pillow splinting
A nurse is planning the care of a client with osteomyelitis that resulted from a diabetic foot ulcer. The client requires a transmetatarsal amputation. When planning the client's postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?
Disturbed Body Image
Which general nursing measure is used for a client with a fracture reduction?
Encourage participation in ADLs
A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)
Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support groups
A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?
Ensure that a large tourniquet is in the room.
The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:
Femoral neck.
A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded?
Grade III
Which term refers to a fracture in which one side of a bone is broken and the other side is bent?
Greenstick
While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?
Hemorrhage and shock
A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade?
III
A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture?
Increase fluid intake and perform prescribed foot exercises.
A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
Keeping a pillow between the client's legs at all times
Pulselessness, a very late sign of compartment syndrome, may signify
Lack of distal tissue perfusion
An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.
Loss of visual acuity Adverse medication effects Slowed reflexes Muscle weakness
A nurse is caring for a client who has suffered an unstable thoracolumbar fracture. What goal should the nurse prioritize during nursing care?
Maintaining spinal alignment
A client is recovering from a below-the-knee traumatic amputation and is 72 hours post surgery. Which actions will the nurse take to promote healing of the wound? Select all that apply.
Measure the residual limb every 8 to 12 hours. Assess neurovascular function of the residual limb. Apply an elastic compression bandage over the wound site.
A client has sustained a long bone fracture and the nurse is preparing the client's care plan. Which of the following should the nurse include in the care plan?
Monitor temperature and pulses of the affected extremity.
Which is a hallmark sign of compartment syndrome?
Pain
A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team?
Promote the client's highest possible level of function.
The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments?
Protection, rest, ice, compression, elevation
Which nursing intervention is essential in caring for a client with compartment syndrome?
Removing all external sources of pressure, such as clothing and jewelry
Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?
Rotator cuff tears
Which term refers to an injury to ligaments and other soft tissues surrounding a joint?
Sprain
Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.
The client with elevated pressure within the muscles The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury
An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?
The importance of adhering to the prescribed treatment and rehabilitation regimen
Which is not one of the general nursing measures employed when caring for the client with a fracture?
cranial nerve assessment
The type of fracture described as having one side of the bone broken and the other side bent would be:
greenstick.
A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?
traction
The client scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the client's concern?
"You will eventually be able to withstand full weight-bearing after the amputation."
A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long?
24 to 48 hours
The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time?
6 to 12 months
A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time?
6 to 8 weeks
What special elements of care should be incorporated into the care of a client in traction? Select all that apply.
All of the answers are true.
A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?
Apply a tourniquet.
A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?
Apply a tourniquet.
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?
Apply ice to the fracture site.
A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client?
Arterial blood gases
A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?
As soon as tolerated, after a reasonable period of immobilization
An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?
Avascular necrosis may develop at the site if it is not promptly resolved
A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.)
Covering the area with a clean dressing if the fracture is open Immobilizing the affected site Splinting the injured limb
The nurse is assessing a client's knee. The area has a grating sensation. What would this be documented as?
Crepitus
Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?
Encourage participation in ADLs
The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action?
Explain the risks of flexion contracture to the client.
A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?
Fat emboli
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?
Fat embolism
A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication?
Fat embolism syndrome
The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:
Fat embolism syndrome
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?
Fat embolism syndrome
Which factor inhibits fracture healing?
History of diabetes
A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?
Inadequate immobilization
A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?
Incomplete
A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?
Infection
A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?
Keep an elastic compression bandage on the ankle.
Which term refers to the failure of fragments of a fractured bone to heal together?
Nonunion
What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture?
Place a pillow between the client's legs when turning.
A client was fitted with an arm cast after fracturing the humerus. Twelve hours after the application of the cast, the client tells the nurse that the injured arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?
Prepare the client for opening or bivalving of the cast.
A nurse is writing a care plan for a client admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a client with an open fracture of the radius?
Risk for infection
A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?
Sprain
Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain?
Take opioid analgesics as prescribed.
Which of the following are associated with compartment syndrome? Select all that apply.
Trauma from accidents Surgery Casts Tight bandages Crushing injuries
A nurse is preparing to discharge an emergency department client who has been fitted with a sling to support her arm after a clavicle fracture. What should the nurse instruct the client to do?
Use the arm for light activities within the range of motion.
A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?
Volkmann's ischemic contracture
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
With the leg on the affected side abducted
There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?
avascular necrosis
When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of
complex regional pain syndrome.
A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?
contusion
A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?
dislocation
A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?
immobilization
The surgical nurse is admitting a client from postanesthetic recovery following the client's below-the-knee amputation. The nurse recognizes the client's high risk for postoperative hemorrhage and should keep what equipment at the bedside?
A tourniquet
A client presents at an ambulatory clinic and reports pain and aching in the lower left leg. After examining the client, a health care provider determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?
After 24 hours, apply heat for periods of 15 to 30 minutes.
A nurse in a busy emergency department provides care for many clients who present with contusions, strains, or sprains. What are treatment modalities that are common to all of these musculoskeletal injuries? Select all that apply.
Applying ice Compression dressings Resting the affected extremity Elevating the injured limb
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?
Between 24 and 48 hours
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?
Hypovolemic
The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?
Hypovolemic
A client has a fractured femur and is being seen in the emergency department. The nurse assessing the area notices there is a grating sound that is suspected to be bone ends moving over one another. This sound is called:
crepitus
A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?
joint manipulation and immobilization
The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse.
notify the orthopedic health care provider immediately bivalving of the cast
A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?
Assess vital signs and level of consciousness.
A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?
Hypovolemic shock
A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"?
stretched or pulled beyond its capacity
A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.
skin breakdown wound infection pneumonia
Which term refers to a break in the continuity of a bone?
Fracture
If a dislocation is not treated promptly, tissue death due to anoxia can occur. This would be documented as which of the following?
Avascular necrosis (AVN)
A fracture is considered pathologic when it
occurs through an area of diseased bone.
A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?
sprain