Nurs 327 musculoskeletal (final chapters)
Delayed union
fracture that has not healed within 6 months of injury
Nonunion
fracture that never heals
Musckuloskeletal system
function is to support and protect the body and to foster movement -bones -joints -muscles -tendons -ligaments -bursae
Osteon
functioning unit of mature cortical bone -AKA the Haversian system
Heterotopic ossification
growth of bone in an area that is normally made of soft tissue
Cortical bone
hard, dense, strong bone that forms the outer layer of bone; also called compact bone -where support is needed -long bones designed for weight bearing
Osteomyelitis treatment
-long course of antibiotics (3 months) IV and oral -surgical debridement -hyperbaric oxygen treatments -unsuccessful treatment can result in amputation
A nurse is teaching a client who is going have a bone scan. Which of the the following statements should the nurse include?
"you will have to urinate just before the procedure."
A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates understanding?
-"I will clean the pins more often if drainage from the pins increases." -"I will use a seperate cotton swab for each pin." -"I will report loosening of the pins to my doctor." -"I will report increased redness at the pin sites."
A nurse is completing preoperative teaching for a client who is undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include?
-"inspect your incision daily for indications of infection" -"apply ice packs to the area for the first 24 hours" -"perform isometric exercises"
A nurse is educating the clients at a health fair about DXA scans. Which of the following information should the nurse include?
-"the hip and spine are the usual areas the device scans." -"bone pain can indicate a need for a scan." -"females should have a baseline scan during their 40s."
Osteoporosis treatment
-Calcium/vitamin D supplementation -bisphosphonates (Aldronate, ibandronate) -Calcitonin -Teriparatide -estrogen/hormone supplements -Raloxifene -Denosumab
A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find?
-Herberdens nodes -enlarged joint size -limp when walking
Hip fracture tx
-OR (general or spinal anesthesia) -reduced using x-ray visualization -internal fixator (nails, screws, plate and screws -total hip replacement
Bone healing
-Reactive phase -Repair phase -Remodel phase
MS diagnostics
-Xray -CT scan - can evaluate further than Xray -MRI - used magnetic fields to evaluate, high resolution pictures of both bone and soft tissues -Safety alert - no metal, including jewelry, hair clips, medication patches, cochlear implants -all can cause burns -Arthrography - contrast is injected into joint cavity -Bone Densitometry - aka Dexa scan -Measures BMD -Bone Mineral Density Arthroscopy - direct visualization into the joint -Arthrocentesis - joint aspiration • Example - knee tap EMG - evaluates muscle and nerve function, common for eval of extent of carpal tunnel • EMG is contraindicated in patients on anticoagluants, because needle can cause bleeding -contraindicated in patients with extensive skin infection, because it can spread these infections into the muscle
A nurse is performing health screens at a health fair. Which of the following clients have a risk factor for osteoporosis?
-a 40-year old who has been taking prednisone for 4 months -a 45-year old client who takes phenytoin for seizures -a 65-year old client who has a sedentary lifestyle -a 70-year old who has smoked for 50 years
Preventing Dislocation of Hip Prosthesis
-abduction pillow -never flex hip more than 90 degrees -affected leg should never turn inward -pivot only on the unaffected leg -never cross legs when sitting -never bend forward to pick something up off the floor -use a higher seat - including a toilet riser
OA risk factors
-aging (over 60) -genetic factors -obesity -females -metabolic disorders
Meds given for fractures
-analgesics -muscle relaxants -stool softener -antibiotic
A nurse is caring for a client who is postoperative following an arthroscopy of the knee. Which of the following actions should the nurse take?
-assess color and temperature of the extremity -place pillows under the extremity -administer analgesic medication -assess pulse and sensation in the foot
A nurse is planning care for a client who will undergo an EMG. Which of the following actions should the nurse include?
-assess for bruising -determine whether the client takes a muscle relaxant -instruct the client to flex muscles during needle insertion
Joint replacement - Nursing care
-assess for risk factors -age, obesity, leg edema, hx DVT, and varicose veins which increase risk for DVT and PE -prevent infection -any infection 2-4 weeks before surgery will delay the surgery -skin prep begins 1-2 days prior to surgery -airborne bacteria can contaminate the wound and is a major cause of most deep infection -persistent infection usually requires joint hardware removal -nurse should encourage ambulation!
Amputation Nursing Interventions
-assess neurovascular and functional status -culture wound for anticipatory antibiotics -assess nutritional status -comorbidities -psychological status -relieve pain -minimize altered sensory perception -phantom limb pain begins 2-3 months after amputation (most frequent in AKA) -PT/OT is a must!!
Nursing assessment (casts)
-assess prior to placing a splint, brace or cast, includes neurovascular status -note degree and location of swelling, bruising, abrasions -assess pain, movement, numbness, tingling and capillary refill distal to the injury site -make sure patient knows why the splint is being applies and expectation of the therapy -rest, Ice, elevate helps control pain (RICE) -unrelieved pain should always be reported -to avoid possible paralysis and necrosis -NEVER ignore complaints of pain from a cast because of the possibility of problems --> impaired tissue perfusion, pressure ulcer under the splint/cast
Osteomyelitis symptoms
-bone pain that is constant, pulsating, localized, and worse with movement -erythema and edema at the site of the infection -fever -leukocytosis and elevated sedimentation rate
Plaster casts
-cheaper, molds better -not as durable -sets in 15-20 minutes but may take 24-72 hours to fully dry -must be protected from wetness
A nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate?
-check CMP device settings -palpate dorsal pedal pulses -elevate heels off bed
A nurse is planning discharge teaching for a client who has a total hip arthroplasty. Which of the following should the nurse include in the teaching?
-clean the incision daily with soap and water -sit in a straight-backed armchair -use a raised toilet seat
Nursing management - fractures
-closed fractures = splint, rest, ice, and elevate -assist in reduction procedure -open fractures = IV, pain control, antibiotics, update tetanus -assist in irrigation and debridement -blood replacement, frequent assessment
Ganglion
-collection of neurologic gelatinous material near tendon sheaths and joints -woman younger than 50 Symptoms -localized tenderness, aching pain -weakness of fingers (tendon involvement) Treatment -aspiration -corticosteroid injection -surgical excision -following treatment --> compression dressing and immobilized splint
Fractures
-complete or incomplete -comminuted -closed fracture - no break in skin -open fracture - bone has broken through skin Grade I - clean wound less than 1 cm Grade II - larger but without extensive soft tissue damage Grade III - highly contaminated, extensive soft tissue damage
Contusions
-contusion = bruising -> rupture of small blood vessels -hematoma -pool of blood under the skin
A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply.)
-crepitus with joint movement -decreased range of motion of the affected joint -joint pain that resolves with rest
Signs of circulation problems
-cyanosis of fingers, swelling -inability to move fingers
Joint replacement complications
-dislocation - hip especially -heterotopic ossification --> formation of bone in the periprosthetic space -avascular necrosis --> bone death due to loss of blood supply -loosening of prosthesis
Dupuytren disease symptoms
-dull, aching discomfort -morning numbness -stiffness in affected fingers Tx: -finger stretching exercises -intra-modular injections of corticosteroids -palmar/digital fasciotomies
Fat embolism signs
-dyspnea, confusion -tachypnea, tachycardia -petechiae -decrease in O2 Tx: supportive (bed rest, IV fluids, O2)
A nurse is presenting information to a group of clients at a health fair about measures to reduce the risk of amputation. Which of the following information should the nurse provide?
-encourage clients who smoke to consider smoking cessation programs -encourage clients who have diabetes mellitus to maintain blood glucose within the expected reference range -instruct clients to unplug electrical equipment when performing repairs -encourage clients who have vascular disease to maintain good foot care
A nurse is completing a preoperative teaching plan for a client who is scheduled to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan?
-encourage complete autologous blood donation -use an abductor pillow when turning the client -perform isometric exercises
A nurse is caring for a client following a below-the-knee amputation. Which of the following actions should the nurse take?
-encourage dependent positioning of the residual limb -inspect for presence and amount of drainage -implement shrinkage intervention of the residual limb -assess for feelings of body image changes
Complications of amputation
-hemorrhage -infection -skin breakdown -phantom limb pain -joint contracture Objective: -heal the wound -handle with care -control edema via compression, rigid cast dressing -elastic residual limb compression -aseptic technique wound care
Preventing fat embolism
-immobilize fractures quickly -support respiratory to prevent complications like PE, ARDS -monitor for compartment syndrome, DVT
Signs of prosthesis hip dislocation
-increased pain at the surgical site -aute groin pain in the affected hip -shortening of the leg -abnormal external or internal rotation -restricted or inability to move the leg -patient reports a popping sensation in the hip
Knee injuries
-lateral and medial collateral ligaments (side impact) -cruciate ligament (anterior or posterior) -meniscal injuries (a cartilage injury)
Fiberglass casts
-lightweight, stronger, more durable -fully rigid in a few minutes -heat reaction may be uncomfortable -some have waterproof lining so it can get wet
Factors that inhibit fracture healing
-local trauma -bone loss -weight bearing prior to approval -malalignment and poor immobilization -space or tissue between the bone fragments -malignancy -lack of blood supply -age and steroids
A nurse is admitting a client an adult client who has suspected osteoporosis. Which of the following findings are risk factors for osteoporosis?
-loss in height of 2 in -BMI of 18 -kyphotic curve at upper thoracic spine -history of lactose intolerance
Traction uses
-minimize spasm -reduce, align and immobilize fractures -increase space between opposing surfaces -traction is primarily short-term straight or running traction --> pulling force in straight line with body part resting on the bed balanced suspension traction --> pulling force with affected extremity off the bed -traction may be applied to the skin or skeleton -manual traction - applied by using hands
Joint replacement
-most joint replacements are metal -cobalt-chromium, titanium or high density polyethylene -joint implants are cemented in place with polymethylmethacrylate (PMMA), a bone bonding agent -loosening is due to cement to bone interface failure is common -accurate fitting, healthy bone, adequate blood supply are important to prevent failure!!
Orthopedic surgeries
-open reduction - surgical reduction of a fracture -internal fixation - plates, screws, nails, wires and or pins to fix the fracture -so an ORIF is both of these
Bone cells
-osteoblasts: bone formation -osteocytes: mature bone cells -osteoclasts: dissolve and reabsorb bone bone tissue is very vascular
Fracture risks
-osteoporosis -paget's disease -long term steroid use, substance abuse -trauma -bone cancer
6 P's of neurovascular compromise
-pain -pallor -pulselessness -paraesthesia -paralysis -poikilothermia (the inability to maintain a constant core temperature)
A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings?
-pain when bearing weight -joint crepitus -swelling of the affected joint -limited joint motion
OA symptoms
-pain with activity that improves at rest -Heberden's and Bouchard's nodes -joint pain and stiffness -crepitus
Fracture manifestations
-pain, deformity, shortening -loss of function -crepitus - grating of bone ends rubbing together -localized edema and ecchymosis Management: -reduced - closed or open -immobilized -fixators (internal or external) -splint -cast -traction
Levels of amputation
-performed at most distal point that will heal successfully -determined by: circulation, functional usefulness objective -to conserve as much length as needed to preserve function and allow for good prosthetic fit
Factors influencing bone remodeling
-physical activity -dietary intake -calcium -vitamin D hormones: -calcitriol -thyroid -cortisol -growth hormone -sex hormones
Physical assessment for MS:
-posture -gait -bone integrity -joint function -muscle size and strength -skin -neurovascular status
Cast syndrome
-psychological - similar to claustrophobia -physiological - related to immobility in the cast -abdominal discomfort and distention -nausea/vomiting -monitor patient in a full body cast for cast sydrome every 4-8 hours!!
Osteoporosis symptoms
-reduced height of 5 to 7.5cm (2 to 3 inches) -acute back pain after lifting or bending -restriction in mvmnt and spinal deformity -history of fractures -pain upon palpation over affected area -thoracic (kyphosis) of the dorsal spine
Reasons to amputate
-relieve symptoms -improve function -save or improve quality of life
Amputation
-removal of a body part - most often lower extremity Why? #1 = peripheral vascular disease, gangrene, trauma, congenital deformity, chronic osteomyelitis, malignant tumor -if upper extremity - usually because of a trauma or tumor
Nursing care for immobilization
-rest, ice over the cast, elevate when sitting or laying -teach how to transfer safely (crutches) -prevent injury to peroneal nerve - foot drop -foot drop is permanent --> results in inability to maintain foot in flexed position
Fractures - early complications
-shock (hypovolemic) -pelvic fractures (open or displaced femoral fracture) -fat embolism - fat globules diffuse from the marrow into the circulation (occurs 12-72 hours after fracture) -respiratory symptoms - occlusion many small pulmonary vessels
Weight-bearing exercise
-support bone maintenance -done while person is on his feet (walking)
Rheumatoid arthritis (RA) symptoms
-swelling, redness -warmth -pain at rest after immobility -morning stiffness
Bursa
-synovial fluid filled sacs fluid-filled sac that allows for easy movement of one part of a joint over another
Isotonic contraction
-tension of the muscle is same -but length of muscle shortens -iso means equal -metric a unit of length
Bone scan
-to detect metastatic cancer -and primary tumors -can detect before it can be seen on Xray -can be used to diagnose stress fractures -requires injection of radioisotope via IV -uptake in damaged bone is greater than surrounding bone
Bursitis and tendonitis
-treatment - pain relief, not cure -most go away on their own -rest -intermittent ice and heat to affected joint -NSAIDS for pain and inflammation -corticosteroid injections - rapid improvement, short-term, most evidenced based -other therapies - expensive and need further supportive research
External fixators
-used to manage open fractures with soft tissue damage -fixators facilitate comfort and early mobility and active exercise of adjacent uninvolved joints, so fewer complications Care: -monitor neurovascular status q 2-4 hours -assess pin sites -pin care directed by orthopedic surgeon -encourage isometric exercise -weight bearing instructions -teach self-care of pins -Never tighten the pins or adjust the clamps!! - provider is responsible for this
Weight resistance exercise
-uses weights or resistance to strengthen muscles -usually uses weights or resistance bands
How many bones are in the body?
206
Cruciate ligament injury
ACL - direct force is forward PCL - direct force is backward
Flexion contractures
Can occur in the hip or knee joint following amputation dt improper positioning Nx Actions - Prevention: ROM exercises and proper positioning - AVOID elevating the stump on a pillow after the first 24 hrs - Have the client lie prone several times a day - DO NOT sit for a long time
Lower back pain manifestations
DISTINGUISHING FACTOR - aggravated by activity -fatigue -paravertebral muscle spasms -pain (acute or chronic) -radiating (leg) -radiculopathy - root -sciatica - nerve -most resolve in 4-6 weeks -thermal application (hot or cold) -spinal manipulation (chiropractor)
Smiths fracture
Fracture of distal radius, hand folded inward
Hip fracture in elderly
PCs = atelectasis, pneumonia, sepsis, DVT, pressure ulcers, delirium Delirium as a result of: -stress of the trauma -unfamiliar surroundings -sleep deprivation -medications
Hip fracture
Two major types Intracapsular (Head and neck of the femur) Extracapsular (Trochanteric ▪ Subtrochanteric) -more women than men -low bone density from osteoporosis all hip fractures are confirmed by X-ray
Osteoporosis
a common chronic metabolic bone disorder resulting in low bone density -occurs when the rate of bone reabsorption (osteoclast cells) exceeds the rate of bone formation (osteoblast cells) resulting in fragile bone tissue and can lead to fractures comm fracture sites: -wrists, hips -spine fractures are the leading complication
Joints
a junction where two or more bones meet -also called "articulation"
Rotator cuff tear
a tear in a tendon that connects one of the rotator muscles to the humeral head -classic sign - they can't do things overhead
Volkmann's contracture
a type of compartment syndrome --> contracture of fingers occurs because of obstructed arterial blood flow to forearm and hand -unrelenting pain, pain on passive stretching, unable to extend fingers -permanent damage!
A nurse is caring for a client who had an above-the-knee amputation. The client reports a sharp, stabbing type of phantom pain. Which of the following actions should the nurse take?
administer an antiepileptic medication
A nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take?
administer an oral dose of Gabapentin to the client -the nurse should administer a nonopioid medication to help minimize phantom limb pain. Gabapentin is an oral antiepileptic medication that is effective for treating sharp, burning, phantom limb pain
A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of a fat embolus?
altered mental status
A nurse is completing discharge teaching who had a wound debridement for osteomyelitis. Which of the following information should the nurse include?
antibiotic therapy should continue for 3 months
Arthroscopy
assesses the condition of a joint and allows repair of tears and other joint defects -most commonly used to evaluate the knee and shoulder joints
Ligaments
attach bone to bone
Tendons
attach muscle to bone
You are the nurse caring for an adult client diagnosed with a back strain. What health education should you provide to this client?
avoid lifting more than one third of body weight without resistance
Greenstick fracture
bending and incomplete break of a bone; most often seen in children
Osteogenesis
bone formation -begins before birth -bone is constantly being turned over - remodeled -bone growth is fastest during teen years -peak bone mass is reached at about age 20 -total skeleton turnover occurs about once every 10 years
A nurse is reviewing the health record of a client who is undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure?
bronchitis 2 weeks ago
Fat embolism
can occur after a fracture, typically within 12 to 48 hrs following long bone fractures or with total joint arthroplasty
A client tells you that he has pain and numbness to his thumb, first finger, and second finger of the right hand. You discover during your health assessment that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client could possibly have what health problem?
carpal tunnel syndrome
Most common type of bone fracture
caused from trauma pathological fractures: -metastatic cancer -osteoporosis -paget's disease
A nurse is caring for a client who has a full arm cast and reports pain of 8 on a scale from 0 to 10 that is unrelieved by pain medication. Which of the following actions should the nurse plan to take first?
check the circulation of the affected extremity
A nurse is caring for a client in balanced suspension skeletal traction who reports intermittent muscle spasms. Which of the following actions should the nurse take first?
check the position of the weights and ropes
A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider?
clear drainage from nose
A nurse is performing a pain assessment on a postoperative client. Which of the following should the nurse use to determine the severity of the client's pain?
client's report on a pain scale
Osteoporosis prevention
consume foods rich in calcium and vitamin D -foods rich in vitamin D --> egg yolks, fish, fortified milk, and cereal -foods rich in calcium --> milk products, green leafy vegetables, fortified orange juice and cereals, red and white beans, and figs -engage in weight-bearing exercises (promotes bone rebuilding and maintenance)
Osteoarthritis (OA)
degenerative joint disease (DJD) -a disorder characterized by progressive deterioration of the articular cartilage -localized inflammatory response
Joint dislocations
dislocation - joint surfaces not in alignment -subluxation - is a partial dislocation -common areas include (shoulder, elbow, neck, patella)
Open (compound) fracture
disrupts the skin integrity, causing an open wound and tissue injury with a risk of infection are graded based upon the extent of tissue injury Grade I: minimal skin damage Grade II: damage includes skin and muscle contusions but without extensive soft tissue injury Grade III: damage is excessive to skin, muscles, nerves, and blood vessels
Colles fracture
distal radius is broken by falling onto an outstretched hand
Closed (simple) fracture
does not break through the skin surface
DXA
dual-energy absorptiometry -estimates the density of bone mass- usually in the hip or spine, and the extent of osteoporosis
A nurse is assessing a client who is quadriplegic secondary to a cervical fracture at vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first?
elevate the head of the client's bed
Carpal tunnel syndrome
entrapment neuropathy - median nerve of the wrist is compressed -(thumb, index, and middle fingers) -frequently women ages 30-60, can use wrist splints to assist Causes: -repetitive hand and wrist movements -rheumatoid arthritis, diabetes, acromegaly -hyperthyroidism, trauma S&S: -pain (night), numbness -paresthesia -weakness -positive Tinel sign
Sprain causes
excessive stretching of a ligament. twisting motions form a fall or sports activity can be the cause of an injury
Strain causes
falls, lifting a heavy item, and exercise
Malunion
fracture heals incorrectly
Impingement syndrome
impaired movement of the rotator cuff -repetitive overhead movement of the arm, or, acute trauma -edema -pain -shoulder tenderness, limited Movement -muscle spasms, disuse atrophy -oral NSAIDS -corticosteroid injections -cold/heat application -therapeutic exercise program - a MUST! (decrease pain, increase function)
Compartment syndrome
increased tissue pressure in a limited space -example: swelling in a cast -pressure compromises the circulation -treat by bi-valving the cast --> if not resolved, fasciotomy
Osteomyelitis
infection of the bone
Epicondylitis
inflammation of the tissues surrounding the elbow Lateral epicondylitis - (tennis elbow) Medial epicondylitis - (golfer's elbow, pitcher's elbow)
Fasciculation
involuntary twitching
Lower back pain
involves any of the 5 lumbar vertebrae and sacrum Common causes include: -acute lumbosacral strain -unstable lumbosacral ligaments -weak muscles -intervertebral disc problems -unequal leg length
Total Joint Replacement (Arthroplasty)
involves replacement of all components of an articulating joint
Total knee arthroplasty
involves the replacement of the distal femoral component, the tibia plate, and the patellar button -total knee arthroplasty is a surgical option when conservative measures fail
Osteomyelitis
is an infection of the bone that begins as an inflammation within the bone secondary to penetration by infectious organisms (virus, bacteria, or fungi) following trauma or surgical repair of a fracture
Neurovascular assessment
is essential throughout immobilization -assessments are performed every hour for the first 24 hr and every 1 to 4 hr after includes -pain -sensation -skin temperature -cap refill -pulses -movement
A nurse is providing dietary teaching about calcium rich foods to a client who has osteoarthritis. Which of the following foods should the nurse include in the instructions?
kale
A nurse is planning care for a client who has a closed head injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority?
maintain a PaCO2 of approximately 35 mmHg
Osteosarcoma
malignant tumor of the bone -most common, most fatal primary malignant bone cancer -prognosis depends on metastasis to lungs at the time the patient seeks health care -most common in children, adolescents, young adults, older adults with Paget disease, radiation exposure -localized bone pain, possible tender, palpable soft tissue mass -primary lesion may involve any bone - most common are distal femur, proximal tibia, proximal humerus
Bone tumor signs
may be symptom free -varying degrees of pain, mild and occasional to constant and severe -varying degrees of disability -obvious bone growth -weight loss, malaise, fever -spinal cord compression -neurologic deficits
Ossification
mineral deposits within the bone that give it strength
Isometric contraction
muscle contracts but there is no movement, muscle stays the same length
Atonic muscle
muscle that has become denervated and can no longer be used, has no tone
Muscle hypertrophy
muscle that has increased in size - exercised
Spastic muscle
muscle that has more than the normal tone
Muscle atrophy
muscle that has wasted away, decreased in size
Flaccid muscle
muscle that is limp and without tone
Epimysium
muscles are encased in fascia
Muscle tone
normal tension of the muscle in a resting state
Low Back Pain (LBP)
occurs along the lumbosacral area of the vertebral column -can be acute or chronic -can be related to an injury, fall, or heavy lifting -leading cause of work disability
Joint mice
particles or loose bodies within a joint -articular cartilage wear and bone erosion cause fragments within the joints -interferes with joint movement ('locking the joint') -arthroscopic surgery!!
Skeletal traction
pins and traction is applied to directly to bone -used to treat fractures of femur, tibia, C-spine -how much weight is applied is dependent on where the txn is applied --> 11-18 kg to achieve therapeutic effect -skeletal traction is usually balance traction monitor for complications: -atelectasis and pneumonia -constipation and anorexia -urinary stasis and subsequent UTI -DVT
A nurse is teaching an assistive personnel (AP) about care of a client following a total hip arthroplasty. Which of the following instructions should the nurse include?
place an abductor pillow between the clients legs when turning the client
A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following actions should the nurse take?
place the client in a supine position
Bone grafting
placement of bone tissue to promote healing or replace diseased bone tissue
A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below-the-knee amputation 24hr ago. Which of the following actions should the nurse take?
position the client prone several times each day
Osteopenia
refers to low mineral density relative to the client's age and sex -BMD peaks between the ages of 18 to 30 -after peak years, bone density decreases
Arthroplasty
refers to the surgical removal of a diseased joint due to osteoarthritis, osteonecrosis, rheumatoid arthritis, trauma, or congenital anomalies, and replacement with prosthetics or artificial components made of metal
A nurse is providing teaching for a client who is prescribed alendronate for osteoporosis. Which of the following information should the nurse include in the teaching?
remain upright for 30 min after taking this medication
A nurse is assessing a client who has a possible head injury following a motor-vehicle crash. The nurse should recognize that which of the following findings indicates increasing intracranial pressure?
restlessness -behavioral changes, such as restlessness and irritability, are early manifestations of increased intracranial pressure
Clonus
rhythmic contraction of the muscle
Metastatic bone disease
secondary bone tumor -lytic lesions: localized destruction -blastic lesions: bone overgrowth -more common than primary -often involve more than one bone (polyostotic) most common primary sites of tumors that metastasize -skull, spine, pelvis, femur, and humerus
A nurse is providing teaching for a client who is postoperative following a right hip arthroplasty. Which of the following images indicates the position the nurse should teach the client to take when sitting in a chair?
sitting normal with feet flat on the floor
Dupuytren disease
slowly progressing contracture of the palmar fascia -flexion of the 4th, 5th, and sometimes middle fingers Causes: -linked to autosomal dominant trait -arthritis, diabetes, gout -cigarette smoking -alcoholism
Splints and braces
splints - short term braces - control and support to prevent injury
Cancellous (trabecular) bone
spongy bone -hematopoiesis and bone formation -flat bones that often protect
Strains and sprains
strain - pulled muscle or tendon 3 degrees 1st - mild stretching 2nd - partial tearing 3rd - severe tearing sprain - injury to ligament or tendons 3 degrees 1st - mild stretching 2nd - partial tearing 3rd -completely torn RICE- rest, ice, elevate, compress
A nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition?
stroke the client's inner thigh
Rheumatoid arthritis (RA)
synovial membrane inflammation resulting in cartilage destruction and bone erosion: inflammatory -affects all joints -can affect lungs, heart, skin, and extra-articular
A nurse in the emergency department is caring for a client after suddenly losing consciousness and falling in her home. The provider determines the client had an embolic stroke. Which of the following medications should the nurse administer?
tissue plasminogen activator -is a thrombolytic agent that should dissolve the blood clot that caused the stroke
A nurse is assessing a client who has rheumatoid arthritis. Which of the following assessment findings should the nurse expect?
ulnar deviation -the inflammation that occurs in the hand joints can make them susceptible to deformity from daily use. Ulnar deviation, or lateral deviation of the fingers, can occur from opening jars and other similar motions
Skin traction
used to control muscle spasm -uses a weight to pull on tape or a boot -weight does not exceed the tolerance of the skin examples: -Bucks traction -cervical head halter -pelvic belt traction Care: -ensure traction is effective -monitor for skin breakdown -monitor for nerve damage -monitor for circulatory impairment
Casts
used to: -immobilize a reduced fracture -correct a deformity -provide uniform pressure to underlying soft tissue -support and stabilize weakened joints -casts permit mobilization while restricting movement of a body part Types: -short arm casts, long arm casts -short leg, long leg casts -walking casts, body casts, spica casts
Pressure ulcers under cast
usually over a boney prominence -patient reports pain, tightness or a warm feeling -drain stain or foul odor -in order to inspect, the provider will either bi-valve the cast or cut a "cast window" -if window, that will have to be repaired to prevent window edema Complications: -disuse syndrome --> muscle atrophy and loss of strength -occurs from not using the muscle -prevented by teaching how to do isometric exercises -do exercises every hour while awake
Bone tumors
various musculoskeletal neoplasms (new, abnormal tissue -can be primary or metastatic tumors from cancers elsewhere in the body a bone tumor causes normal bone tissue to react -adjacent normal bone alters its normal pattern of remodeling -malignant bone tumors invade and destroy adjacent bone tissue -osteoblastic vs Osteolytic
Fracture healing
weeks to months to heal -adequate blood supply is necessary -flat bones heal more quickly -fractures at the ends of bones heal more quickly -weight bearing stimulates bone growth -proper nutrition is essential
