CHA2: LP9

What is myositis ossificans?

(Complications of Fracture Healing) -Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

What is angulation?

(Complications of Fracture Healing) -Fracture heals in abnormal position in relation to midline of structure (type of malunion)

What is nonunion?

(Complications of Fracture Healing) -fracture fail to heal despite treatment -no x-ray evidence of callus formation

What is delayed union?

(Complications of Fracture Healing) -fracture healing progresses more slowly than expected -healing eventually occurs

What is malunion?

(Complications of Fracture Healing) -fracture heals in expected time but in unsatisfactory position, possible resulting in deformity or dysfunction

What is a refracture?

(Complications of Fracture Healing) -new fracture occurs at original fracture site

What is a pseudoarthrosis?

(Complications of Fracture Healing) -type of nonunion occurring at fracture site in which a false join is formed with abnormal movement at site

Explain the Autoimmune Theory.

(Possible Cause of Rheumatoid Arthritis) -Changes start with initial immune response between host & antigen -Abnormal antibody forms (IgG) -Body makes autoantibody against the abnormal IgG (Autoantibody is called Rheumatoid Factor [RF]) -RF combines with IgG & settles into synovial membrane -Sets up inflammatory response (Immune system attacks its own body tissues)

Explain the Genetic Factor Theory.

(Possible Cause of Rheumatoid Arthritis) -Genetic predisposition -Human leukocyte antigen (HLA-DR4)

What is the peak onset for Juvenile Arthritis?

-1 to 4 years of age

What are some factors that affect fracture healing?

-Age -Blood supply to the area -Size of involved bone -Location of the fracture -Displacement of the fracture -Immobilization/Lack of immobilization -Infection -Nutrition -Systemic disease

What are some possible causes of rheumatoid arthritis?

-Autoimmune theory -Genetic factor theory

How is Paget's Disease treated?

-Calcitonin -Bisphosphonates -NSAIDs -Non-pharmacologic: firm mattress, corsets -PT: good body mechanics, increase muscle strength -Proper nutrition: Vitamin D, Calcium, Protein

What is Paget's Disease?

-Chronic disorder -Abnormal remodeling & resorption of bone -Replacement of normal marrow with vascular connective tissue -elevated alka phos

What is Juvenile Arthritis?

-Chronic joint inflammation -Leading cause of childhood disability

What are some potential complications from Juvenile Arthritis?

-Chronic uveitis (Inflammation of eye structures) (Can lead to vision loss) -Interference with growth

What is rheumatoid arthritis?

-Chronic, systemic autoimmune disease -Inflammation & destruction of connective tissue in synovial joints -Periods of remission and exacerbation

What are some complications of fractures?

-Compartment Syndrome -Venous Thromboembolism/DVT -Pulmonary Embolism (PE) -Fat Embolism Syndrome

What are some complications of fracture healing?

-Delayed union -Nonunion -Malunion -Angulation -Pseudoarthrosis -Refracture -Myositis Ossificans

What is osteoarthriris (OA)?

-Idiopathic: cause is unknown -Secondary disorder: caused by a known event that directly damages cartilage

What are some types of fractures?

-Open -Closed -Transverse -Spiral -Greenstick -Comminuted -Oblique -Patholigc -Stress

What are some s/s of osteoarthriris (OA)?

-Systemic—none Joints: -Pain -Stiffness -Crepitus -Deformity

What are the stages of fracture healing?

1) Hematoma 2) Granulation 3) Callus Formation 4) Ossification 5) Consolidation 6) Remodeling

In monitoring a patient's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? (SELECT ALL THAT APPLY) A) Symptom control during periods of emotional stress. B) Normal white blood cell, platelet, and neutrophil counts. C) Radiological finding that show nonprogression of joint degeneration. D) An increased range of motion in the affected joints 3 months into therapy. E) Inflammation and irritation at the injection site 3 days after the injection. F) A low-grade temperature on arising that remains throughout the day.

A) Symptom control during periods of emotional stress. B) Normal white blood cell, platelet, and neutrophil counts. C) Radiological finding that show nonprogression of joint degeneration. D) An increased range of motion in the affected joints 3 months into therapy.

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? A) The patient's blood glucose is 165 mg/dL. B) The patient has no improvement in symptoms. C) The patient has experienced a recent 5-pound weight loss. D) The patient's erythrocyte sedimentation rate (ESR) has increased.

A) The patient's blood glucose is 165 mg/dL.

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of these prescribed collaborative interventions will the nurse implement first? A) Wrap the ankle and apply an ice pack. B) Administer naproxen (Naprosyn) 500 mg PO. C) Give acetaminophen with codeine (Tylenol #3). D) Take the patient to the radiology department for x-rays.

A) Wrap the ankle and apply an ice pack.

After the nurse has finished teaching a patient with osteoarthritis (OA) of the left hip and knee about how to manage the OA, which patient statement indicates a need for more education? A) "I can take glucosamine to help decrease my knee pain." B) "I will take 1 g of acetaminophen (Tylenol) every 4 hours." C) "I will take a shower in the morning to help relieve stiffness." D) "I can use a cane to decrease the pressure and pain in my hip."

B) "I will take 1 g of acetaminophen (Tylenol) every 4 hours."

The nurse is preparing to assist a patient who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which action should the nurse take? A) Use a mechanical lift to transfer the patient from the bed to the chair. B) Check the postoperative orders for the patient's weight-bearing status. C) Avoid administration of pain medications before getting the patient up. D) Delegate the transfer of the patient out of bed to a certified nursing assistant (CNA)

B) Check the postoperative orders for the patient's weight-bearing status.

A nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Select all the instructions that would be included on the list. A) Use fingertips to lift the cast while it is drying. B) Keep small toys and sharp objects away from the cast. C) Use a padded ruler or other padded object to scratch the skin under the cast if it itches. D) Contact the physician if the child complains of numbness or tingling in the extremity. E) Place gauze around the damp cast's edges to pad for roughness. F) Place arm in a dependent position for the first 24 to 48 hours. G) Move the left elbow and fingers regularly.

B) Keep small toys and sharp objects away from the cast. D) Contact the physician if the child complains of numbness or tingling in the extremity. G) Move the left elbow and fingers regularly.

Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis (OA) of the left knee? A) Heberden's nodules B) Pain upon joint movement C) Redness and swelling of the knee joint D) Stiffness that increases with movement

B) Pain upon joint movement

When planning care for a patient who has had hip replacement surgery, which nursing action can the nurse delegate to experienced certified nursing assistants (CNA)? A) Teach quadriceps-setting exercises. B) Reposition the patient every 1 to 2 hours. C) Assess for skin irritation on the patient's back. D) Determine the patient's pain level and tolerance.

B) Reposition the patient every 1 to 2 hours.

A patient has hip replacement surgery using the posterior approach. Which patient action requires rapid intervention by the nurse? A) The patient uses crutches with a swing-to gait. B) The patient leans over to pull shoes and socks on. C) The patient sits straight up on the edge of the bed. D) The patient bends over the sink while brushing the teeth.

B) The patient leans over to pull shoes and socks on.

What is a transverse fracture?

Bone breaks from right to left in the transverse plane

The mother of a child with juvenile arthritis (JA) calls the clinic nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child can perform range-of-motion exercise at this time. the appropriate nursing response is: A) "Avoid all exercise during painful periods." B) "Range-of-motion exercises must be performed every day." C) "Have the child perform simple isometric exercises during this time." D) "Give additional pain medication before performing range-of-motion."

C) "Have the child perform simple isometric exercises during this time."

Which of these patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? A) A 56-year-old man who is a member of a construction crew B) A 24-year-old man who participates in a summer softball team C) A 49-year-old woman who works on an automotive assembly line D) A 36-year-old woman who is newly diagnosed with diabetes mellitus

C) A 49-year-old woman who works on an automotive assembly line

A patient with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's best response is based on the understanding that Buck's traction primarily: A) Allows bony healing to begin before surgery B) Provides rigid immobilization of the fracture site C) Provides comfort by reducing muscle spasms D) Lengthens the fractured leg to prevent severing of blood vessels

C) Provides comfort by reducing muscle spasms

A nurse is caring for a patient who had an above-the-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately: A) Calls the physician B) Applies ice to the site C) Rewraps the stump with an elastic compression bandage D) Applies a dry sterile dressing and elevates it on one pillow

C) Rewraps the stump with an elastic compression bandage

A nurse is conducting a health screening for osteoporosis. Which of the following clients is at greatest risk of developing osteoporosis? A) A 25-year-old woman who jogs B) A 36-year-old man who has asthma C) A 70-year-old man who consumes excess alcohol D) A sedentary 65-year-old woman who smokes cigarettes.

D) A sedentary 65-year-old woman who smokes cigarettes.

The second day after admission with a fractured pelvis, a patient develops acute onset confusion. Which action should the nurse take first? A) Take the blood pressure. B) Assess patient orientation. C) Check pupil reaction to light. D) Assess the oxygen saturation.

D) Assess the oxygen saturation.

A patient with diabetes mellitus has had a right below-the-knee amputation. The nurse would assess specifically for which of the following signs and symptoms because of this disease history? A) Hemorrhage B) Edema of the stump C) Slight redness of incision D) Separating of wound edges

D) Separating of wound edges

Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse instructs the patient to: A) Take the medication at bedtime to avoid gastrointestinal upset. B) Take the medication in the morning with breakfast. C) Lie down for 30 minutes after taking the medication. D) Take the medication with a full glass of water after arising.

D) Take the medication with a full glass of water after arising.

A patient is admitted to the emergency department with possible left lower leg fractures. The initial action by the nurse should be to A) elevate the left leg. B) splint the lower leg. C) obtain information about the tetanus immunization status. D) check the popliteal, dorsalis pedis, and posterior tibial pulses.

D) check the popliteal, dorsalis pedis, and posterior tibial pulses.

A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should A) loosen the traction and have the patient turn onto the unaffected side. B) place a pillow between the patient's legs and turn gently to each side. C) turn the patient partially to each side with the assistance of another nurse. D) have the patient lift the buttocks by bending and pushing with the left leg.

D) have the patient lift the buttocks by bending and pushing with the left leg.

When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to A) do stretching and warm-up exercises before starting work. B) wrap the wrists with a compression bandage every morning. C) use acetaminophen (Tylenol) instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain. D) obtain a keyboard pad to support the wrist while word processing.

D) obtain a keyboard pad to support the wrist while word processing.

What is compartment syndrome?

Damage to nerves and vasculature of an extremity due to compression

What are some s/s of Rheumatoid Arthritis?

Joints: -Stiffness -Pain -Limitation in movement -Inflammation -Deformity -Disability Extra-articular: -Rheumatoid nodules -Sjögren's syndrome -Felty syndrome

What are some s/s of Juvenile Arthritis?

Joints: -Swelling -Stiffness -Warm to touch -Red -Limited ROM -Limp -Slow or uneven growth of extremities -Fever -Rash -Lymphadenopathy -Splenomegaly -Hepatomegaly

Explain the criteria for diagnosing Rheumatoid Arthritis.

The following must be present for at least 6 weeks: -Morning stiffness that lasts ≥1 hour -Swelling in three or more joints -Swelling in hand joints -Symmetric joint swelling -Erosions or decalcification seen on handx-rays -Rheumatoid nodules -Presence of serum RF

What is a pathologic fracture?

There was underlying bone pathology before the fracture. Ex. Paget's disease --> lytic lesions of the bone

What is a comminuted fracture?

When the bone is splintered or crushed and has multiple fragments

What is a greenstick fracture?

an incomplete fracture

What is a closed fracture?

break that does not penetrate the skin

What is an open fracture?

broken bone that penetrates the skin

What is a spiral fracture?

caused by twisting a bone excessively

What is an oblique fracture?

occurs at an angle other than a right angle to the axis of the bone