MS 1: Management of Patients with Musculoskeletal Disorders

Common adverse effects

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?

L4, L5, and S1 **L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve rots as they leave the spinal canal, which results in pain that radiates along the nerve.

A client visits an orthopedic specialist because of pain beginning in the low back back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?

Have the client hold the palm of the hand up while the nurse percusses over the median nerve. **If tingling, numbness, or pain is felt when the median nerve is percussed, the the Tinel's sign is considered positive.

A healthcare provider asks the nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment.

Perform neuromuscular assessment every hour **Early detection of neurological and perfusion problems is important to prevent complications from the surgery

A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing car plan?

Chlorpheniramine

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?

"I will avoid prolonged sitting or walking"

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

Aldendronate (Fosamax)

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? **Bisphosphonates are drugs that work by slowing down bone loss

Quadriceps

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

Athroscopy

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

Encourage the client to walk in the hall

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

Decreased height

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?

Broccoli (calcium rich vegetable)

What food can the nurse suggest to the client at risk for osteoporosis?

Dupuytren contracture

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Lower lumbar

Which area of the spinal cord is subject to the greatest mechanical stress and degenerative changes?

Surgical debridement

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

Being male

Which is not a risk factor for osteoporosis?

Radiculopathy

Which term refers to a disease of a nerve root. **Can be from a pinched nerve or a tumor.

- Elevate the affected leg - Apply ice packs to the affected knee - Apply a knee brace or wrap the affected bone **Client has a torn lateral meniscus. RICE = Rest, Ice, Compression, Elevate

A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which interventions are appropriate nursing actions? Select all that apply:

"You will receive IV antibiotics for 3 to 6 weeks." **Osteomyelitis is inflammation or swelling that occurs in the bone. It can be from an infection somewhere else in the body that traveled to the bone, or occur in the bone to start from an injury.

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

Immobilize the client's arm **When a nurse suspects a fracture, the extremity should be immobilized before moving the body part.

A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

During a routine physical exam on an older female client, a nurse notes that the client is 5 ft, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 ft and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

Plantar fasciitis

Which of the following presents with an onset of heel pain with the first steps of the morning?

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." **Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome and avoid hyperextension of the wrist. Wrist (not arm) splints can also help.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

The recommended daily allowance of calcium may be found in a wide variety of foods **Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Although supplements are available, they aren't always necessary.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?

Include calcium, phosphorous, and vitamin D supplements **Also include adequate nutrition, exposure to sunlight, and progressive exercise and ambulation

Which aspect should a nurse include in the teaching plan for a client with osteomalacia?

European American women **small-frame, nonobese European American women Asian American women of slight build are at risk for low peak bone mineral density.

Which group is at greatest risk for osteoporosis?

surgical debridement

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?